{"hospital_name":"The Mount Sinai Hospital","last_updated_on":"2026-04-01","version":"3.0.0","location_name":["The Mount Sinai Hospital"],"hospital_address":["One Gustave L Levy Place, New York, NY 10029"],"license_information":{"license_number":"7002024H","state":"NY"},"type_2_npi":["1497992218","1336441559"],"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":"Brent Estes"},"financial_aid_policy":["Mount Sinai has a 10% discount on gross charges for the discount cash price."],"modifier_information":[{"description":"Services delivered under an outpatient physical therapy plan of care","code":"GP","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Aetna HMO/POS/PPO Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Signature Administrators/TPA - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Whole Health-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 3-4  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amida Care","plan_name":"Amida Care Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beacon","plan_name":"Beacon Medicaid CHP/FHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna - Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna HMO/OAP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna LocalPlus - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI Network Access - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI PPO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP HMO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage (SNP) - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Select Care - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC -  Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Access Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Connection Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Individual Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - PPO/EPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Small Group Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis EP 1 -  2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare INN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare ONN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Non Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Humana Medicare-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Local 1199","plan_name":"1199 SEIU - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm JIB - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Preferred - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Standard - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Ind Members - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Small Group - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - All Payer - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Essential Plan - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid Family - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid SCHIP/Child - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Select Health Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare EP 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare Medicaid/CHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"WellCare Medicare/FIDA - TMSH","description":"The modified price is presented in the standard charge value."}]},{"description":"Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities","code":"TC","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Aetna HMO/POS/PPO Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Signature Administrators/TPA - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Whole Health-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 3-4  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amida Care","plan_name":"Amida Care Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beacon","plan_name":"Beacon Medicaid CHP/FHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna - Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna HMO/OAP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna LocalPlus - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI Network Access - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI PPO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP HMO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage (SNP) - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Select Care - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC -  Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Access Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Connection Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Individual Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - PPO/EPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Small Group Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis EP 1 -  2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare INN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare ONN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Non Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Humana Medicare-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Local 1199","plan_name":"1199 SEIU - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm JIB - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Preferred - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Standard - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Ind Members - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Small Group - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - All Payer - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Essential Plan - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid Family - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid SCHIP/Child - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Select Health Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare EP 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare Medicaid/CHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"WellCare Medicare/FIDA - TMSH","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient occupational therapy plan of care","code":"GO","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Aetna HMO/POS/PPO Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Signature Administrators/TPA - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Whole Health-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 3-4  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amida Care","plan_name":"Amida Care Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beacon","plan_name":"Beacon Medicaid CHP/FHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna - Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna HMO/OAP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna LocalPlus - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI Network Access - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI PPO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP HMO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage (SNP) - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Select Care - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC -  Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Access Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Connection Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Individual Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - PPO/EPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Small Group Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis EP 1 -  2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare INN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare ONN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Non Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Humana Medicare-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Local 1199","plan_name":"1199 SEIU - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm JIB - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Preferred - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Standard - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Ind Members - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Small Group - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - All Payer - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Essential Plan - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid Family - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid SCHIP/Child - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Select Health Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare EP 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare Medicaid/CHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"WellCare Medicare/FIDA - TMSH","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient speech language pathology plan of care","code":"GN","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Aetna HMO/POS/PPO Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Signature Administrators/TPA - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Whole Health-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 3-4  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amida Care","plan_name":"Amida Care Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beacon","plan_name":"Beacon Medicaid CHP/FHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna - Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna HMO/OAP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna LocalPlus - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI Network Access - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI PPO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP HMO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage (SNP) - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Select Care - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC -  Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Access Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Connection Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Individual Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - PPO/EPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Small Group Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis EP 1 -  2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare INN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare ONN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Non Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Humana Medicare-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Local 1199","plan_name":"1199 SEIU - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm JIB - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Preferred - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Standard - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Ind Members - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Small Group - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - All Payer - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Essential Plan - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid Family - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid SCHIP/Child - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Select Health Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare EP 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare Medicaid/CHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"WellCare Medicare/FIDA - TMSH","description":"The modified price is presented in the standard charge value."}]},{"description":"Item provided without cost to provider, supplier or practitioner, or full credit received for replaced device (examples, but not limited to, covered under warranty, replaced due to defect, free samples)","code":"FB","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Aetna HMO/POS/PPO Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Signature Administrators/TPA - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Whole Health-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 3-4  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amida Care","plan_name":"Amida Care Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beacon","plan_name":"Beacon Medicaid CHP/FHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna - Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna HMO/OAP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna LocalPlus - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI Network Access - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI PPO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP HMO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage (SNP) - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Select Care - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC -  Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Access Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Connection Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Individual Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - PPO/EPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Small Group Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis EP 1 -  2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare INN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare ONN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Non Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Humana Medicare-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Local 1199","plan_name":"1199 SEIU - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm JIB - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Preferred - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Standard - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Ind Members - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Small Group - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - All Payer - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Essential Plan - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid Family - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid SCHIP/Child - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Select Health Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare EP 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare Medicaid/CHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"WellCare Medicare/FIDA - TMSH","description":"The modified price is presented in the standard charge value."}]},{"description":"Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional","code":"76","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Aetna HMO/POS/PPO Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Signature Administrators/TPA - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Whole Health-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 3-4  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amida Care","plan_name":"Amida Care Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beacon","plan_name":"Beacon Medicaid CHP/FHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna - Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna HMO/OAP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna LocalPlus - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI Network Access - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI PPO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP HMO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage (SNP) - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Select Care - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC -  Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Access Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Connection Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Individual Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - PPO/EPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Small Group Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis EP 1 -  2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare INN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare ONN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Non Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Humana Medicare-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Local 1199","plan_name":"1199 SEIU - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm JIB - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Preferred - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Standard - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Ind Members - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Small Group - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - All Payer - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Essential Plan - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid Family - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid SCHIP/Child - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Select Health Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare EP 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare Medicaid/CHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"WellCare Medicare/FIDA - TMSH","description":"The modified price is presented in the standard charge value."}]},{"description":"Requirements specified in the medical policy have been met","code":"KX","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Aetna HMO/POS/PPO Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Signature Administrators/TPA - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Whole Health-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 3-4  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amida Care","plan_name":"Amida Care Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beacon","plan_name":"Beacon Medicaid CHP/FHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna - Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna HMO/OAP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna LocalPlus - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI Network Access - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI PPO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP HMO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage (SNP) - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Select Care - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC -  Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Access Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Connection Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Individual Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - PPO/EPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Small Group Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis EP 1 -  2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare INN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare ONN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Non Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Humana Medicare-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Local 1199","plan_name":"1199 SEIU - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm JIB - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Preferred - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Standard - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Ind Members - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Small Group - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - All Payer - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Essential Plan - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid Family - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid SCHIP/Child - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Select Health Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare EP 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare Medicaid/CHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"WellCare Medicare/FIDA - TMSH","description":"The modified price is presented in the standard charge value."}]},{"description":"Medicaid level of care 1, as defined by each state","code":"U1","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Aetna HMO/POS/PPO Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Signature Administrators/TPA - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Whole Health-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 3-4  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amida Care","plan_name":"Amida Care Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beacon","plan_name":"Beacon Medicaid CHP/FHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna - Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna HMO/OAP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna LocalPlus - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI Network Access - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI PPO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP HMO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage (SNP) - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Select Care - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC -  Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Access Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Connection Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Individual Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - PPO/EPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Small Group Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis EP 1 -  2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare INN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare ONN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Non Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Humana Medicare-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Local 1199","plan_name":"1199 SEIU - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm JIB - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Preferred - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Standard - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Ind Members - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Small Group - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - All Payer - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Essential Plan - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid Family - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid SCHIP/Child - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Select Health Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare EP 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare Medicaid/CHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"WellCare Medicare/FIDA - TMSH","description":"The modified price is presented in the standard charge value."}]},{"description":"Medicaid level of care 9, as defined by each state","code":"U9","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Aetna HMO/POS/PPO Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Signature Administrators/TPA - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Whole Health-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 3-4  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amida Care","plan_name":"Amida Care Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beacon","plan_name":"Beacon Medicaid CHP/FHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna - Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna HMO/OAP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna LocalPlus - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI Network Access - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI PPO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP HMO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage (SNP) - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Select Care - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC -  Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Access Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Connection Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Individual Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - PPO/EPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Small Group Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis EP 1 -  2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare INN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare ONN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Non Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Humana Medicare-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Local 1199","plan_name":"1199 SEIU - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm JIB - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Preferred - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Standard - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Ind Members - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Small Group - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - All Payer - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Essential Plan - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid Family - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid SCHIP/Child - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Select Health Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare EP 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare Medicaid/CHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"WellCare Medicare/FIDA - TMSH","description":"The modified price is presented in the standard charge value."}]},{"description":"Modifier description not available","code":"93","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Aetna HMO/POS/PPO Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Signature Administrators/TPA - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Whole Health-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 3-4  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amida Care","plan_name":"Amida Care Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beacon","plan_name":"Beacon Medicaid CHP/FHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna - Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna HMO/OAP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna LocalPlus - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI Network Access - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI PPO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP HMO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage (SNP) - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Select Care - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC -  Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Access Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Connection Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Individual Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - PPO/EPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Small Group Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis EP 1 -  2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare INN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare ONN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Non Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Humana Medicare-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Local 1199","plan_name":"1199 SEIU - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm JIB - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Preferred - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Standard - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Ind Members - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Small Group - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - All Payer - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Essential Plan - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid Family - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid SCHIP/Child - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Select Health Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare EP 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare Medicaid/CHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"WellCare Medicare/FIDA - TMSH","description":"The modified price is presented in the standard charge value."}]},{"description":"Medicaid level of care 2, as defined by each state","code":"U2","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Aetna HMO/POS/PPO Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Signature Administrators/TPA - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Whole Health-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 3-4  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amida Care","plan_name":"Amida Care Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beacon","plan_name":"Beacon Medicaid CHP/FHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna - Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna HMO/OAP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna LocalPlus - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI Network Access - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI PPO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP HMO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage (SNP) - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Select Care - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC -  Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Access Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Connection Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Individual Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - PPO/EPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Small Group Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis EP 1 -  2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare INN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare ONN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Non Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Humana Medicare-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Local 1199","plan_name":"1199 SEIU - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm JIB - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Preferred - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Standard - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Ind Members - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Small Group - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - All Payer - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Essential Plan - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid Family - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid SCHIP/Child - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Select Health Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare EP 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare Medicaid/CHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"WellCare Medicare/FIDA - TMSH","description":"The modified price is presented in the standard charge value."}]},{"description":"Medicaid level of care 4, as defined by each state","code":"U4","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Aetna HMO/POS/PPO Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Signature Administrators/TPA - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Whole Health-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 3-4  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amida Care","plan_name":"Amida Care Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beacon","plan_name":"Beacon Medicaid CHP/FHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna - Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna HMO/OAP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna LocalPlus - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI Network Access - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI PPO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP HMO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage (SNP) - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Select Care - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC -  Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Access Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Connection Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Individual Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - PPO/EPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Small Group Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis EP 1 -  2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare INN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare ONN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Non Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Humana Medicare-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Local 1199","plan_name":"1199 SEIU - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm JIB - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Preferred - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Standard - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Ind Members - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Small Group - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - All Payer - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Essential Plan - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid Family - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid SCHIP/Child - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Select Health Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare EP 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare Medicaid/CHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"WellCare Medicare/FIDA - TMSH","description":"The modified price is presented in the standard charge value."}]},{"description":"Mental health program","code":"HE","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Aetna HMO/POS/PPO Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Signature Administrators/TPA - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Whole Health-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 3-4  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amida Care","plan_name":"Amida Care Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beacon","plan_name":"Beacon Medicaid CHP/FHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna - Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna HMO/OAP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna LocalPlus - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI Network Access - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI PPO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP HMO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage (SNP) - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Select Care - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC -  Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Access Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Connection Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Individual Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - PPO/EPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Small Group Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis EP 1 -  2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare INN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare ONN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Non Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Humana Medicare-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Local 1199","plan_name":"1199 SEIU - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm JIB - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Preferred - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Standard - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Ind Members - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Small Group - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - All Payer - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Essential Plan - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid Family - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid SCHIP/Child - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Select Health Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare EP 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare Medicaid/CHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"WellCare Medicare/FIDA - TMSH","description":"The modified price is presented in the standard charge value."}]},{"description":"Medicaid level of care 5, as defined by each state","code":"U5","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Aetna HMO/POS/PPO Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Signature Administrators/TPA - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Whole Health-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 3-4  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amida Care","plan_name":"Amida Care Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beacon","plan_name":"Beacon Medicaid CHP/FHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna - Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna HMO/OAP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna LocalPlus - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI Network Access - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI PPO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP HMO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage (SNP) - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Select Care - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC -  Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Access Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Connection Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Individual Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - PPO/EPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Small Group Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis EP 1 -  2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare INN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare ONN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Non Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Humana Medicare-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Local 1199","plan_name":"1199 SEIU - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm JIB - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Preferred - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Standard - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Ind Members - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Small Group - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - All Payer - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Essential Plan - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid Family - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid SCHIP/Child - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Select Health Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare EP 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare Medicaid/CHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"WellCare Medicare/FIDA - TMSH","description":"The modified price is presented in the standard charge value."}]},{"description":"Item or service expected to be denied as not reasonable and necessary","code":"GZ","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Aetna HMO/POS/PPO Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Signature Administrators/TPA - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Whole Health-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 3-4  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amida Care","plan_name":"Amida Care Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beacon","plan_name":"Beacon Medicaid CHP/FHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna - Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna HMO/OAP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna LocalPlus - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI Network Access - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI PPO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP HMO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage (SNP) - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Select Care - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC -  Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Access Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Connection Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Individual Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - PPO/EPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Small Group Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis EP 1 -  2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare INN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare ONN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Non Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Humana Medicare-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Local 1199","plan_name":"1199 SEIU - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm JIB - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Preferred - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Standard - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Ind Members - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Small Group - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - All Payer - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Essential Plan - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid Family - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid SCHIP/Child - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Select Health Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare EP 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare Medicaid/CHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"WellCare Medicare/FIDA - TMSH","description":"The modified price is presented in the standard charge value."}]},{"description":"Clia waived test","code":"QW","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Aetna HMO/POS/PPO Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Signature Administrators/TPA - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Whole Health-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 3-4  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amida Care","plan_name":"Amida Care Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beacon","plan_name":"Beacon Medicaid CHP/FHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna - Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna HMO/OAP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna LocalPlus - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI Network Access - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI PPO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP HMO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage (SNP) - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Select Care - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC -  Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Access Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Connection Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Individual Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - PPO/EPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Small Group Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis EP 1 -  2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare INN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare ONN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Non Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Humana Medicare-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Local 1199","plan_name":"1199 SEIU - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm JIB - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Preferred - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Standard - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Ind Members - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Small Group - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - All Payer - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Essential Plan - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid Family - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid SCHIP/Child - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Select Health Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare EP 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare Medicaid/CHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"WellCare Medicare/FIDA - TMSH","description":"The modified price is presented in the standard charge value."}]},{"description":"Investigational clinical service provided in a clinical research study that is in an approved clinical research study","code":"Q0","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Aetna HMO/POS/PPO Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Signature Administrators/TPA - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Whole Health-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 3-4  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amida Care","plan_name":"Amida Care Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beacon","plan_name":"Beacon Medicaid CHP/FHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna - Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna HMO/OAP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna LocalPlus - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI Network Access - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI PPO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP HMO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage (SNP) - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Select Care - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC -  Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Access Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Connection Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Individual Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - PPO/EPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Small Group Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis EP 1 -  2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare INN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare ONN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Non Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Humana Medicare-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Local 1199","plan_name":"1199 SEIU - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm JIB - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Preferred - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Standard - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Ind Members - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Small Group - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - All Payer - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Essential Plan - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid Family - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid SCHIP/Child - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Select Health Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare EP 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare Medicaid/CHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"WellCare Medicare/FIDA - TMSH","description":"The modified price is presented in the standard charge value."}]},{"description":"Routine clinical service provided in a clinical research study that is in an approved clinical research study","code":"Q1","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Aetna HMO/POS/PPO Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Signature Administrators/TPA - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Whole Health-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 3-4  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amida Care","plan_name":"Amida Care Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beacon","plan_name":"Beacon Medicaid CHP/FHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna - Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna HMO/OAP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna LocalPlus - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI Network Access - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI PPO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP HMO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage (SNP) - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Select Care - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC -  Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Access Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Connection Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Individual Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - PPO/EPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Small Group Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis EP 1 -  2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare INN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare ONN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Non Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Humana Medicare-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Local 1199","plan_name":"1199 SEIU - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm JIB - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Preferred - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Standard - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Ind Members - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Small Group - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - All Payer - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Essential Plan - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid Family - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid SCHIP/Child - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Select Health Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare EP 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare Medicaid/CHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"WellCare Medicare/FIDA - TMSH","description":"The modified price is presented in the standard charge value."}]},{"description":"Substance abuse program","code":"HF","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Aetna HMO/POS/PPO Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Signature Administrators/TPA - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Whole Health-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 3-4  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amida Care","plan_name":"Amida Care Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beacon","plan_name":"Beacon Medicaid CHP/FHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna - Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna HMO/OAP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna LocalPlus - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI Network Access - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI PPO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP HMO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage (SNP) - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Select Care - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC -  Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Access Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Connection Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Individual Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - PPO/EPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Small Group Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis EP 1 -  2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare INN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare ONN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Non Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Humana Medicare-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Local 1199","plan_name":"1199 SEIU - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm JIB - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Preferred - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Standard - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Ind Members - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Small Group - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - All Payer - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Essential Plan - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid Family - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid SCHIP/Child - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Select Health Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare EP 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare Medicaid/CHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"WellCare Medicare/FIDA - TMSH","description":"The modified price is presented in the standard charge value."}]},{"description":"Complex/high tech level of care","code":"TG","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Aetna HMO/POS/PPO Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Signature Administrators/TPA - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Whole Health-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 3-4  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amida Care","plan_name":"Amida Care Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beacon","plan_name":"Beacon Medicaid CHP/FHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna - Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna HMO/OAP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna LocalPlus - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI Network Access - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI PPO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP HMO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage (SNP) - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Select Care - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC -  Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Access Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Connection Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Individual Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - PPO/EPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Small Group Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis EP 1 -  2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare INN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare ONN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Non Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Humana Medicare-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Local 1199","plan_name":"1199 SEIU - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm JIB - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Preferred - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Standard - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Ind Members - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Small Group - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - All Payer - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Essential Plan - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid Family - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid SCHIP/Child - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Select Health Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare EP 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare Medicaid/CHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"WellCare Medicare/FIDA - TMSH","description":"The modified price is presented in the standard charge value."}]},{"description":"Service provided as part of medicaid early periodic screening diagnosis and treatment (epsdt) program","code":"EP","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Aetna HMO/POS/PPO Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Signature Administrators/TPA - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Whole Health-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 3-4  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amida Care","plan_name":"Amida Care Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beacon","plan_name":"Beacon Medicaid CHP/FHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna - Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna HMO/OAP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna LocalPlus - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI Network Access - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI PPO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP HMO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage (SNP) - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Select Care - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC -  Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Access Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Connection Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Individual Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - PPO/EPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Small Group Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis EP 1 -  2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare INN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare ONN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Non Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Humana Medicare-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Local 1199","plan_name":"1199 SEIU - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm JIB - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Preferred - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Standard - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Ind Members - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Small Group - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - All Payer - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Essential Plan - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid Family - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid SCHIP/Child - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Select Health Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare EP 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare Medicaid/CHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"WellCare Medicare/FIDA - TMSH","description":"The modified price is presented in the standard charge value."}]},{"description":"Emergency services","code":"ET","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Aetna HMO/POS/PPO Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Signature Administrators/TPA - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Whole Health-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 3-4  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amida Care","plan_name":"Amida Care Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beacon","plan_name":"Beacon Medicaid CHP/FHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna - Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna HMO/OAP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna LocalPlus - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI Network Access - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI PPO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP HMO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage (SNP) - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Select Care - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC -  Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Access Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Connection Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Individual Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - PPO/EPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Small Group Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis EP 1 -  2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare INN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare ONN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Non Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Humana Medicare-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Local 1199","plan_name":"1199 SEIU - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm JIB - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Preferred - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Standard - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Ind Members - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Small Group - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - All Payer - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Essential Plan - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid Family - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid SCHIP/Child - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Select Health Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare EP 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare Medicaid/CHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"WellCare Medicare/FIDA - TMSH","description":"The modified price is presented in the standard charge value."}]},{"description":"Via interactive audio and video telecommunication systems","code":"GT","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Aetna HMO/POS/PPO Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Signature Administrators/TPA - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Whole Health-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 3-4  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amida Care","plan_name":"Amida Care Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beacon","plan_name":"Beacon Medicaid CHP/FHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna - Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna HMO/OAP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna LocalPlus - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI Network Access - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI PPO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP HMO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage (SNP) - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Select Care - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC -  Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Access Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Connection Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Individual Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - PPO/EPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Small Group Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis EP 1 -  2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare INN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare ONN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Non Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Humana Medicare-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Local 1199","plan_name":"1199 SEIU - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm JIB - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Preferred - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Standard - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Ind Members - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Small Group - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - All Payer - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Essential Plan - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid Family - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid SCHIP/Child - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Select Health Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare EP 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare Medicaid/CHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"WellCare Medicare/FIDA - TMSH","description":"The modified price is presented in the standard charge value."}]},{"description":"Follow-up service","code":"TS","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Aetna HMO/POS/PPO Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Signature Administrators/TPA - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Whole Health-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 3-4  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amida Care","plan_name":"Amida Care Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beacon","plan_name":"Beacon Medicaid CHP/FHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna - Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna HMO/OAP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna LocalPlus - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI Network Access - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI PPO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP HMO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage (SNP) - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Select Care - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC -  Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Access Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Connection Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Individual Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - PPO/EPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Small Group Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis EP 1 -  2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare INN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare ONN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Non Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Humana Medicare-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Local 1199","plan_name":"1199 SEIU - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm JIB - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Preferred - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Standard - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Ind Members - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Small Group - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - All Payer - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Essential Plan - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid Family - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid SCHIP/Child - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Select Health Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare EP 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare Medicaid/CHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"WellCare Medicare/FIDA - TMSH","description":"The modified price is presented in the standard charge value."}]},{"description":"Group setting","code":"HQ","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Aetna HMO/POS/PPO Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Signature Administrators/TPA - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Whole Health-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 3-4  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amida Care","plan_name":"Amida Care Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beacon","plan_name":"Beacon Medicaid CHP/FHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna - Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna HMO/OAP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna LocalPlus - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI Network Access - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI PPO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP HMO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage (SNP) - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Select Care - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC -  Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Access Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Connection Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Individual Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - PPO/EPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Small Group Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis EP 1 -  2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare INN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare ONN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Non Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Humana Medicare-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Local 1199","plan_name":"1199 SEIU - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm JIB - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Preferred - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Standard - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Ind Members - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Small Group - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - All Payer - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Essential Plan - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid Family - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid SCHIP/Child - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Select Health Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare EP 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare Medicaid/CHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"WellCare Medicare/FIDA - TMSH","description":"The modified price is presented in the standard charge value."}]},{"description":"Services provided on behalf of the client to someone other than the client (collateral relationship)","code":"UK","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Aetna HMO/POS/PPO Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Signature Administrators/TPA - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Whole Health-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 3-4  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amida Care","plan_name":"Amida Care Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beacon","plan_name":"Beacon Medicaid CHP/FHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna - Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna HMO/OAP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna LocalPlus - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI Network Access - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI PPO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP HMO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage (SNP) - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Select Care - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC -  Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Access Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Connection Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Individual Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - PPO/EPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Small Group Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis EP 1 -  2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare INN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare ONN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Non Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Humana Medicare-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Local 1199","plan_name":"1199 SEIU - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm JIB - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Preferred - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Standard - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Ind Members - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Small Group - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - All Payer - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Essential Plan - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid Family - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid SCHIP/Child - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Select Health Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare EP 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare Medicaid/CHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"WellCare Medicare/FIDA - TMSH","description":"The modified price is presented in the standard charge value."}]},{"description":"Medically necessary service or supply","code":"SC","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Aetna HMO/POS/PPO Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Signature Administrators/TPA - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Whole Health-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 3-4  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amida Care","plan_name":"Amida Care Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beacon","plan_name":"Beacon Medicaid CHP/FHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna - Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna HMO/OAP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna LocalPlus - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI Network Access - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI PPO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP HMO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage (SNP) - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Select Care - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC -  Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Access Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Connection Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Individual Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - PPO/EPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Small Group Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis EP 1 -  2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare INN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare ONN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Non Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Humana Medicare-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Local 1199","plan_name":"1199 SEIU - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm JIB - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Preferred - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Standard - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Ind Members - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Small Group - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - All Payer - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Essential Plan - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid Family - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid SCHIP/Child - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Select Health Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare EP 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare Medicaid/CHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"WellCare Medicare/FIDA - TMSH","description":"The modified price is presented in the standard charge value."}]},{"description":"Child/adolescent program","code":"HA","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Aetna HMO/POS/PPO Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Signature Administrators/TPA - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Whole Health-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 3-4  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amida Care","plan_name":"Amida Care Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beacon","plan_name":"Beacon Medicaid CHP/FHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna - Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna HMO/OAP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna LocalPlus - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI Network Access - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI PPO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP HMO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage (SNP) - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Select Care - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC -  Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Access Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Connection Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Individual Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - PPO/EPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Small Group Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis EP 1 -  2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare INN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare ONN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Non Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Humana Medicare-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Local 1199","plan_name":"1199 SEIU - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm JIB - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Preferred - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Standard - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Ind Members - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Small Group - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - All Payer - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Essential Plan - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid Family - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid SCHIP/Child - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Select Health Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare EP 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare Medicaid/CHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"WellCare Medicare/FIDA - TMSH","description":"The modified price is presented in the standard charge value."}]},{"description":"Specialized mental health programs for high-risk populations","code":"HK","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Aetna HMO/POS/PPO Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Signature Administrators/TPA - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Whole Health-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 3-4  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amida Care","plan_name":"Amida Care Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beacon","plan_name":"Beacon Medicaid CHP/FHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna - Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna HMO/OAP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna LocalPlus - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI Network Access - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI PPO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP HMO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage (SNP) - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Select Care - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC -  Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Access Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Connection Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Individual Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - PPO/EPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Small Group Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis EP 1 -  2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare INN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare ONN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Non Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Humana Medicare-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Local 1199","plan_name":"1199 SEIU - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm JIB - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Preferred - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Standard - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Ind Members - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Small Group - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - All Payer - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Essential Plan - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid Family - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid SCHIP/Child - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Select Health Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare EP 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare Medicaid/CHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"WellCare Medicare/FIDA - TMSH","description":"The modified price is presented in the standard charge value."}]},{"description":"Masters degree level","code":"HO","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Aetna HMO/POS/PPO Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Signature Administrators/TPA - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Whole Health-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 3-4  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amida Care","plan_name":"Amida Care Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beacon","plan_name":"Beacon Medicaid CHP/FHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna - Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna HMO/OAP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna LocalPlus - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI Network Access - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI PPO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP HMO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage (SNP) - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Select Care - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC -  Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Access Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Connection Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Individual Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - PPO/EPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Small Group Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis EP 1 -  2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare INN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare ONN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Non Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Humana Medicare-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Local 1199","plan_name":"1199 SEIU - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm JIB - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Preferred - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Standard - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Ind Members - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Small Group - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - All Payer - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Essential Plan - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid Family - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid SCHIP/Child - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Select Health Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare EP 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare Medicaid/CHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"WellCare Medicare/FIDA - TMSH","description":"The modified price is presented in the standard charge value."}]},{"description":"Less than bachelor degree level","code":"HM","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Aetna HMO/POS/PPO Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Signature Administrators/TPA - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Whole Health-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 3-4  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amida Care","plan_name":"Amida Care Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beacon","plan_name":"Beacon Medicaid CHP/FHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna - Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna HMO/OAP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna LocalPlus - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI Network Access - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI PPO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP HMO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage (SNP) - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Select Care - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC -  Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Access Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Connection Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Individual Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - PPO/EPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Small Group Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis EP 1 -  2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare INN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare ONN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Non Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Humana Medicare-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Local 1199","plan_name":"1199 SEIU - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm JIB - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Preferred - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Standard - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Ind Members - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Small Group - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - All Payer - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Essential Plan - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid Family - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid SCHIP/Child - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Select Health Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare EP 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare Medicaid/CHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"WellCare Medicare/FIDA - TMSH","description":"The modified price is presented in the standard charge value."}]},{"description":"Family/couple with client present","code":"HR","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Aetna HMO/POS/PPO Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Signature Administrators/TPA - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Whole Health-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 3-4  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amida Care","plan_name":"Amida Care Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beacon","plan_name":"Beacon Medicaid CHP/FHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna - Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna HMO/OAP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna LocalPlus - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI Network Access - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI PPO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP HMO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage (SNP) - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Select Care - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC -  Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Access Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Connection Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Individual Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - PPO/EPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Small Group Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis EP 1 -  2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare INN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare ONN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Non Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Humana Medicare-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Local 1199","plan_name":"1199 SEIU - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm JIB - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Preferred - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Standard - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Ind Members - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Small Group - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - All Payer - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Essential Plan - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid Family - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid SCHIP/Child - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Select Health Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare EP 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare Medicaid/CHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"WellCare Medicare/FIDA - TMSH","description":"The modified price is presented in the standard charge value."}]},{"description":"Family/couple without client present","code":"HS","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Aetna HMO/POS/PPO Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Signature Administrators/TPA - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Whole Health-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 3-4  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amida Care","plan_name":"Amida Care Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beacon","plan_name":"Beacon Medicaid CHP/FHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna - Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna HMO/OAP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna LocalPlus - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI Network Access - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI PPO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP HMO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage (SNP) - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Select Care - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC -  Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Access Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Connection Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Individual Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - PPO/EPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Small Group Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis EP 1 -  2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare INN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare ONN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Non Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Humana Medicare-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Local 1199","plan_name":"1199 SEIU - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm JIB - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Preferred - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Standard - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Ind Members - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Small Group - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - All Payer - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Essential Plan - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid Family - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid SCHIP/Child - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Select Health Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare EP 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare Medicaid/CHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"WellCare Medicare/FIDA - TMSH","description":"The modified price is presented in the standard charge value."}]},{"description":"Two patients served","code":"UN","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Aetna HMO/POS/PPO Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Signature Administrators/TPA - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Whole Health-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 3-4  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amida Care","plan_name":"Amida Care Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beacon","plan_name":"Beacon Medicaid CHP/FHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna - Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna HMO/OAP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna LocalPlus - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI Network Access - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI PPO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP HMO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage (SNP) - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Select Care - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC -  Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Access Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Connection Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Individual Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - PPO/EPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Small Group Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis EP 1 -  2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare INN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare ONN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Non Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Humana Medicare-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Local 1199","plan_name":"1199 SEIU - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm JIB - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Preferred - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Standard - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Ind Members - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Small Group - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - All Payer - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Essential Plan - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid Family - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid SCHIP/Child - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Select Health Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare EP 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare Medicaid/CHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"WellCare Medicare/FIDA - TMSH","description":"The modified price is presented in the standard charge value."}]},{"description":"Three patients served","code":"UP","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Aetna HMO/POS/PPO Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Signature Administrators/TPA - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Whole Health-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Essential Plan 3-4  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Affinity","plan_name":"Affinity Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amida Care","plan_name":"Amida Care Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beacon","plan_name":"Beacon Medicaid CHP/FHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna - Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna HMO/OAP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna LocalPlus - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI Network Access - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem GHI PPO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP HMO COMM - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem HIP Medicare Advantage (SNP) - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Emblem","plan_name":"Emblem Select Care - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC -  Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Access Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Blue Priority PPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Connection Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HealthPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - HMO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Individual Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - PPO/EPO - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empire BC","plan_name":"Empire BC - Small Group Network - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis EP 1 -  2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Fidelis","plan_name":"Fidelis Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare INN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthfirst","plan_name":"Healthfirst Medicare ONN-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Non Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Horizon","plan_name":"Horizon - Omnia - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Humana Medicare-TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Local 1199","plan_name":"1199 SEIU - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm JIB - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Preferred - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"MagnaCare","plan_name":"MagnaCare Comm Standard - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 1-2 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus  EP 3-4 - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Exchange - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Metroplus","plan_name":"MetroPlus Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Ind Members - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Oscar Commercial - Small Group - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Commercial - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oxford","plan_name":"Oxford Indemnity - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - All Payer - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Essential Plan - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare - Medicare Adv - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid Family - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Medicaid SCHIP/Child - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Medicare Advantage - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"VNS","plan_name":"VNS Select Health Medicaid - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare EP 1-2  - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Wellcare Medicaid/CHP - TMSH","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"WellCare Medicare/FIDA - TMSH","description":"The modified price is presented in the standard charge value."}]}],"standard_charge_information":[{"description":"PLATE IMPLANT RECONSTRUCTION 3.5MM 11HOLE 130MM L","code_information":[{"code":"0000065","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1562.75,"discounted_cash":1406.48,"setting":"both","billing_class":"facility"}]},{"description":"EPHEDrine 50 mg/10 mL (5 mg/mL) syringe 10 mL Syringe","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"00000Rx00000000027","type":"CDM"},{"code":"250","type":"RC"},{"code":"0000000027","type":"NDC"}],"standard_charges":[{"gross_charge":29.73,"discounted_cash":26.76,"setting":"both","billing_class":"facility","additional_generic_notes":"NDC EA = 1 ML"}]},{"description":"vancomycin 5 mg/mL enema 100 mL 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paying.","code_information":[{"code":"1240000009","type":"CDM"},{"code":"0124","type":"RC"}],"standard_charges":[{"gross_charge":250.00,"discounted_cash":225.0,"setting":"both","billing_class":"facility"}]},{"description":"Used to write off differential amount for private rooms when accommodation reason is hospital convenience.","code_information":[{"code":"1240000010","type":"CDM"},{"code":"0124","type":"RC"}],"standard_charges":[{"gross_charge":250.00,"discounted_cash":225.0,"setting":"both","billing_class":"facility"}]},{"description":"HC Heart Symp Image Plnr","code_information":[{"code":"1240331T","type":"CDM"},{"code":"0341","type":"RC"},{"code":"0331T","type":"HCPCS"}],"standard_charges":[{"gross_charge":2300.00,"discounted_cash":2070.0,"setting":"both","billing_class":"facility"}]},{"description":"HC Heart Symp Image 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Mdl","code_information":[{"code":"1240503T","type":"CDM"},{"code":"0480","type":"RC"},{"code":"0503T","type":"HCPCS"}],"standard_charges":[{"gross_charge":5000.00,"discounted_cash":4500.0,"setting":"both","billing_class":"facility"}]},{"description":"Njx Px Prq Tx Xtr Pseudoarysm - 36002","code_information":[{"code":"12436002","type":"CDM"},{"code":"0360","type":"RC"},{"code":"36002","type":"HCPCS"}],"standard_charges":[{"gross_charge":1620.00,"discounted_cash":1458.0,"setting":"both","billing_class":"facility"}]},{"description":"Intro Ndl/Intracath Xtr Art - 36140","code_information":[{"code":"12436140","type":"CDM"},{"code":"0360","type":"RC"},{"code":"36140","type":"HCPCS"}],"standard_charges":[{"gross_charge":1215.00,"discounted_cash":1093.5,"setting":"both","billing_class":"facility"}]},{"description":"HC Cta Neck W W/O Contrast","code_information":[{"code":"12470498","type":"CDM"},{"code":"0351","type":"RC"},{"code":"70498","type":"HCPCS"}],"standard_charges":[{"gross_charge":3950.00,"discounted_cash":3555.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"HC CT Thorax WO Contrast","code_information":[{"code":"12471250","type":"CDM"},{"code":"0352","type":"RC"},{"code":"71250","type":"HCPCS"}],"standard_charges":[{"gross_charge":2000.00,"discounted_cash":1800.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"HC CT Thorax W/ Contrast","code_information":[{"code":"12471260","type":"CDM"},{"code":"0352","type":"RC"},{"code":"71260","type":"HCPCS"}],"standard_charges":[{"gross_charge":2885.00,"discounted_cash":2596.5,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"HC CT Thorax W&WO Contrast","code_information":[{"code":"12471270","type":"CDM"},{"code":"0352","type":"RC"},{"code":"71270","type":"HCPCS"}],"standard_charges":[{"gross_charge":3225.00,"discounted_cash":2902.5,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"HC Cta Chest Noncornr W W/O Contrast","code_information":[{"code":"12471275","type":"CDM"},{"code":"0352","type":"RC"},{"code":"71275","type":"HCPCS"}],"standard_charges":[{"gross_charge":3700.00,"discounted_cash":3330.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"HC Cta Pelvis W W/O Contrast","code_information":[{"code":"12472191","type":"CDM"},{"code":"0352","type":"RC"},{"code":"72191","type":"HCPCS"}],"standard_charges":[{"gross_charge":2700.00,"discounted_cash":2430.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"HC CT Pelvis WO Contrast","code_information":[{"code":"12472192","type":"CDM"},{"code":"0352","type":"RC"},{"code":"72192","type":"HCPCS"}],"standard_charges":[{"gross_charge":2000.00,"discounted_cash":1800.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"HC Cta Upper Extremity W&WO Contrast","code_information":[{"code":"12473206","type":"CDM"},{"code":"0352","type":"RC"},{"code":"73206","type":"HCPCS"}],"standard_charges":[{"gross_charge":2500.00,"discounted_cash":2250.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"HC Cta Lower Extremity W&WO Contrat","code_information":[{"code":"12473706","type":"CDM"},{"code":"0352","type":"RC"},{"code":"73706","type":"HCPCS"}],"standard_charges":[{"gross_charge":2600.00,"discounted_cash":2340.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"HC CT Abdomen W/O Contrast","code_information":[{"code":"12474150","type":"CDM"},{"code":"0352","type":"RC"},{"code":"74150","type":"HCPCS"}],"standard_charges":[{"gross_charge":1800.00,"discounted_cash":1620.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. 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It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"HC CT Heart W/Contr Congen 3d","code_information":[{"code":"12475573","type":"CDM"},{"code":"0350","type":"RC"},{"code":"75573","type":"HCPCS"}],"standard_charges":[{"gross_charge":2325.00,"discounted_cash":2092.5,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. 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It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"3d Rndr I&R CT MRI US/Oth X Req Postpcx - 76376","code_information":[{"code":"12476376","type":"CDM"},{"code":"0400","type":"RC"},{"code":"76376","type":"HCPCS"}],"standard_charges":[{"gross_charge":1000.00,"discounted_cash":900.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"3d Rndr I&R CT MRI US/Oth Req Postpcx - 76377","code_information":[{"code":"12476377","type":"CDM"},{"code":"0400","type":"RC"},{"code":"76377","type":"HCPCS"}],"standard_charges":[{"gross_charge":1300.00,"discounted_cash":1170.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"HC US Abdl Aorta Screening Study Aaa","code_information":[{"code":"12476706","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76706","type":"HCPCS"}],"standard_charges":[{"gross_charge":850.00,"discounted_cash":765.0,"setting":"both","billing_class":"facility"}]},{"description":"US Rpr B-Scan&/R-T Img Lmtd - 76775","code_information":[{"code":"12476775","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76775","type":"HCPCS"}],"standard_charges":[{"gross_charge":1175.00,"discounted_cash":1057.5,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"HC US Exam Kidney Transpl W/Dopp","code_information":[{"code":"12476776","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76776","type":"HCPCS"}],"standard_charges":[{"gross_charge":750.00,"discounted_cash":675.0,"setting":"both","billing_class":"facility"}]},{"description":"HC Umbilical Artery Echo Fetal","code_information":[{"code":"12476820","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76820","type":"HCPCS"}],"standard_charges":[{"gross_charge":610.00,"discounted_cash":549.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"HC Middle Cerebral Artery Echo","code_information":[{"code":"12476821","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76821","type":"HCPCS"}],"standard_charges":[{"gross_charge":845.00,"discounted_cash":760.5,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Echo Ftl Cv Sys R-T Rec - 76825","code_information":[{"code":"12476825","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76825","type":"HCPCS"}],"standard_charges":[{"gross_charge":1620.00,"discounted_cash":1458.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"HC Echocardiography Fetal Rpt/Fu","code_information":[{"code":"12476826","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76826","type":"HCPCS"}],"standard_charges":[{"gross_charge":1350.00,"discounted_cash":1215.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"HC Echo Exam Fetal Heart Complete","code_information":[{"code":"12476827","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76827","type":"HCPCS"}],"standard_charges":[{"gross_charge":810.00,"discounted_cash":729.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"HC Echocard Fetal Doppler Rpt/Fu","code_information":[{"code":"12476828","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76828","type":"HCPCS"}],"standard_charges":[{"gross_charge":530.00,"discounted_cash":477.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"US Ndl Plmt Img S&I - 76942","code_information":[{"code":"12476942","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76942","type":"HCPCS"}],"standard_charges":[{"gross_charge":2900.00,"discounted_cash":2610.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"HC Myocrd Img Pet 1 Std W/CT","code_information":[{"code":"12478429","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78429","type":"HCPCS"}],"standard_charges":[{"gross_charge":7020.00,"discounted_cash":6318.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"HC Myocrd Img Rst/Strs 1 Std CT","code_information":[{"code":"12478430","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78430","type":"HCPCS"}],"standard_charges":[{"gross_charge":7020.00,"discounted_cash":6318.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"HC Myocard Img Pet Perfus Multp","code_information":[{"code":"12478431","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78431","type":"HCPCS"}],"standard_charges":[{"gross_charge":8775.00,"discounted_cash":7897.5,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"HC Myocrd Img Dual Raiotracer","code_information":[{"code":"12478432","type":"CDM"},{"code":"0340","type":"RC"},{"code":"78432","type":"HCPCS"}],"standard_charges":[{"gross_charge":9000.00,"discounted_cash":8100.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"HC Myocrd Img Dual Radiotrace CT","code_information":[{"code":"12478433","type":"CDM"},{"code":"0340","type":"RC"},{"code":"78433","type":"HCPCS"}],"standard_charges":[{"gross_charge":10800.00,"discounted_cash":9720.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"HC Aqumbf Pet Rest and Rx Stress","code_information":[{"code":"12478434","type":"CDM"},{"code":"0340","type":"RC"},{"code":"78434","type":"HCPCS"}],"standard_charges":[{"gross_charge":2025.00,"discounted_cash":1822.5,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"HC Myocardial Spect Single Study at Rest or Stress","code_information":[{"code":"12478451","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78451","type":"HCPCS"}],"standard_charges":[{"gross_charge":3780.00,"discounted_cash":3402.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"HC Myocardial Spect Multiple Studies","code_information":[{"code":"12478452","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78452","type":"HCPCS"}],"standard_charges":[{"gross_charge":5875.00,"discounted_cash":5287.5,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"HC Card Blood Pool Gated Planar 1 Study Rest/Stress","code_information":[{"code":"12478472","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78472","type":"HCPCS"}],"standard_charges":[{"gross_charge":3240.00,"discounted_cash":2916.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"HC Muga Spect W Wm and Ef","code_information":[{"code":"12478494","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78494","type":"HCPCS"}],"standard_charges":[{"gross_charge":1830.00,"discounted_cash":1647.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"HC Radiopharm Localization Tumor Spect 1 Area Single Day Imaging","code_information":[{"code":"12478803","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78803","type":"HCPCS"}],"standard_charges":[{"gross_charge":4725.00,"discounted_cash":4252.5,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"HC Ekg Tracing W Min 12 Leads","code_information":[{"code":"12493005","type":"CDM"},{"code":"0730","type":"RC"},{"code":"93005","type":"HCPCS"}],"standard_charges":[{"gross_charge":395.00,"discounted_cash":355.5,"setting":"both","billing_class":"facility"}]},{"description":"HC Cardiovascular Stress Test W/ Ecg","code_information":[{"code":"12493017","type":"CDM"},{"code":"0482","type":"RC"},{"code":"93017","type":"HCPCS"}],"standard_charges":[{"gross_charge":1700.00,"discounted_cash":1530.0,"setting":"both","billing_class":"facility"}]},{"description":"Tte F/Cgen Car Anomal Compl - 93303","code_information":[{"code":"12493303","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93303","type":"HCPCS"}],"standard_charges":[{"gross_charge":2900.00,"discounted_cash":2610.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Tte F/Cgen Car Anomal F-Up/Lmtd Std - 93304","code_information":[{"code":"12493304","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93304","type":"HCPCS"}],"standard_charges":[{"gross_charge":2025.00,"discounted_cash":1822.5,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"HC Echo 2d Transthoracic W Doppler Complete","code_information":[{"code":"12493306","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93306","type":"HCPCS"}],"standard_charges":[{"gross_charge":3645.00,"discounted_cash":3280.5,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Tee R-T Img 2d +-M-Mode Rec Compl - 93307","code_information":[{"code":"12493307","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93307","type":"HCPCS"}],"standard_charges":[{"gross_charge":2295.00,"discounted_cash":2065.5,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Tee R-T Img 2d +-M-Mode Rec F-Up/Lmtd - 93308","code_information":[{"code":"12493308","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93308","type":"HCPCS"}],"standard_charges":[{"gross_charge":1900.00,"discounted_cash":1710.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Tee R-T Img 2d W/Prb Img Acquisj I&R - 93312","code_information":[{"code":"12493312","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93312","type":"HCPCS"}],"standard_charges":[{"gross_charge":3900.00,"discounted_cash":3510.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Tee R-T Img 2d W/Probe Plmt Only - 93313","code_information":[{"code":"12493313","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93313","type":"HCPCS"}],"standard_charges":[{"gross_charge":3400.00,"discounted_cash":3060.0,"setting":"both","billing_class":"facility"}]},{"description":"Tee R-T Img 2d Img Acquisj I&R Only - 93314","code_information":[{"code":"12493314","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93314","type":"HCPCS"}],"standard_charges":[{"gross_charge":1635.00,"discounted_cash":1471.5,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Tee Cgen Car Anoml Prb Acquisj I&R - 93315","code_information":[{"code":"12493315","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93315","type":"HCPCS"}],"standard_charges":[{"gross_charge":3800.00,"discounted_cash":3420.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Tee Cgen Car Anoml Plmt Prb Only - 93316","code_information":[{"code":"12493316","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93316","type":"HCPCS"}],"standard_charges":[{"gross_charge":2700.00,"discounted_cash":2430.0,"setting":"both","billing_class":"facility"}]},{"description":"Tee Cgen Car Anoml Img Acquisj I&R - 93317","code_information":[{"code":"12493317","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93317","type":"HCPCS"}],"standard_charges":[{"gross_charge":1500.00,"discounted_cash":1350.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"HC 3d Echo Img Cgen Car Anom Add","code_information":[{"code":"12493319","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93319","type":"HCPCS"}],"standard_charges":[{"gross_charge":1000.00,"discounted_cash":900.0,"setting":"both","billing_class":"facility"}]},{"description":"Dop Echo Compl - 93320","code_information":[{"code":"12493320","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93320","type":"HCPCS"}],"standard_charges":[{"gross_charge":2935.00,"discounted_cash":2641.5,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Dop Echo P-W&/or Cont W/Spectral F-Up/Lmtd Std - 93321","code_information":[{"code":"12493321","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93321","type":"HCPCS"}],"standard_charges":[{"gross_charge":1800.00,"discounted_cash":1620.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Dop Echo Color Flo Vel Mapg - 93325","code_information":[{"code":"12493325","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93325","type":"HCPCS"}],"standard_charges":[{"gross_charge":2000.00,"discounted_cash":1800.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"HC Stress Tte 2d W Ecg Recording","code_information":[{"code":"12493351","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93351","type":"HCPCS"}],"standard_charges":[{"gross_charge":3750.00,"discounted_cash":3375.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"HC Echo Tee for Structure Interv","code_information":[{"code":"12493355","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93355","type":"HCPCS"}],"standard_charges":[{"gross_charge":3000.00,"discounted_cash":2700.0,"setting":"both","billing_class":"facility"}]},{"description":"HC Myocrd Strain Img Spckl Trck","code_information":[{"code":"12493356","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93356","type":"HCPCS"}],"standard_charges":[{"gross_charge":2300.00,"discounted_cash":2070.0,"setting":"both","billing_class":"facility"}]},{"description":"HC Distal Protection Device Inse","code_information":[{"code":"12493799","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93799","type":"HCPCS"}],"standard_charges":[{"gross_charge":5000.00,"discounted_cash":4500.0,"setting":"both","billing_class":"facility"}]},{"description":"Dup-Scan Xtrc Art Compl Bi Std - 93880","code_information":[{"code":"12493880","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93880","type":"HCPCS"}],"standard_charges":[{"gross_charge":2160.00,"discounted_cash":1944.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Dup-Scan Xtrc Art Uni/Lmtd Std - 93882","code_information":[{"code":"12493882","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93882","type":"HCPCS"}],"standard_charges":[{"gross_charge":1485.00,"discounted_cash":1336.5,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"N-Invas Physiologic Std Upr/Lxtr Art 1 Lvl Bi - 93922","code_information":[{"code":"12493922","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93922","type":"HCPCS"}],"standard_charges":[{"gross_charge":1455.00,"discounted_cash":1309.5,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"N-Invas Physiologic Std Upr/Lxtr Blat Mlt Lvl Bi - 93923","code_information":[{"code":"12493923","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93923","type":"HCPCS"}],"standard_charges":[{"gross_charge":2135.00,"discounted_cash":1921.5,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"N-Invas Physiologic Std Lxtr Art Rest Flwg Strs - 93924","code_information":[{"code":"12493924","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93924","type":"HCPCS"}],"standard_charges":[{"gross_charge":1470.00,"discounted_cash":1323.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Dup-Scan Lxtr Art/Artl Bpgs Compl Bi Std - 93925","code_information":[{"code":"12493925","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93925","type":"HCPCS"}],"standard_charges":[{"gross_charge":2300.00,"discounted_cash":2070.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Dup-Scan Lxtr Art/Artl Bpgs Uni/Lmtd Std - 93926","code_information":[{"code":"12493926","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93926","type":"HCPCS"}],"standard_charges":[{"gross_charge":1500.00,"discounted_cash":1350.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Dup-Scan Uxtr Art/Artl Bpgs Compl Bi Std - 93930","code_information":[{"code":"12493930","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93930","type":"HCPCS"}],"standard_charges":[{"gross_charge":2300.00,"discounted_cash":2070.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Dup-Scan Uxtr Art/Artl Bpgs Uni/Lmtd Std - 93931","code_information":[{"code":"12493931","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93931","type":"HCPCS"}],"standard_charges":[{"gross_charge":1200.00,"discounted_cash":1080.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Dup-Scan Xtr Veins Compl Bi Std - 93970","code_information":[{"code":"12493970","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93970","type":"HCPCS"}],"standard_charges":[{"gross_charge":2400.00,"discounted_cash":2160.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Dup-Scan Xtr Veins Uni/Lmtd Std - 93971","code_information":[{"code":"12493971","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93971","type":"HCPCS"}],"standard_charges":[{"gross_charge":1500.00,"discounted_cash":1350.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Dup-Scan Artl Flo Abdl/Pel/Scrot&/Rpr Orgn Compl - 93975","code_information":[{"code":"12493975","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93975","type":"HCPCS"}],"standard_charges":[{"gross_charge":2700.00,"discounted_cash":2430.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Dup-Scan Artl Flo Abdl/Pel/Scrot&/Rpr Orgn Lmtd - 93976","code_information":[{"code":"12493976","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93976","type":"HCPCS"}],"standard_charges":[{"gross_charge":2230.00,"discounted_cash":2007.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Dup-Scan Aorta Ivc Iliac Vascl/Bpgs Compl - 93978","code_information":[{"code":"12493978","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93978","type":"HCPCS"}],"standard_charges":[{"gross_charge":2700.00,"discounted_cash":2430.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. 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