{"hospital_name":"Mount Sinai Brooklyn","last_updated_on":"2026-04-01","version":"3.0.0","location_name":["Mount Sinai Brooklyn"],"hospital_address":["3201 Kings Highway, Brooklyn, NY 11234"],"license_information":{"license_number":"7002024H","state":"NY"},"type_2_npi":["1780111484"],"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":"Drug amount discarded/not administered to any patient","code":"JW","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 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":"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":"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":"State supplied vaccine","code":"SL","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":"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":2187.85,"discounted_cash":1969.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: FS 870"}]},{"description":"vancomycin 5 mg/mL enema 100 mL Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"00000Rx00000000027","type":"CDM"},{"code":"636","type":"RC"},{"code":"27","type":"NDC"}],"standard_charges":[{"gross_charge":8.81,"discounted_cash":7.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"methadone 2.5 mg Half Tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"00000Rx00000000030","type":"CDM"},{"code":"636","type":"RC"},{"code":"S0109","type":"HCPCS"},{"code":"30","type":"NDC"}],"standard_charges":[{"gross_charge":1.49,"discounted_cash":1.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 EACH"}]},{"description":"quetiapine 12.5 mg Half Tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"00000Rx00000000031","type":"CDM"},{"code":"250","type":"RC"},{"code":"31","type":"NDC"}],"standard_charges":[{"gross_charge":0.44,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"traZODONE 25 mg Half Tablet 1 half tablet BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"00000Rx00000000032","type":"CDM"},{"code":"250","type":"RC"},{"code":"32","type":"NDC"}],"standard_charges":[{"gross_charge":0.5,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 HALF TABLET"}]},{"description":"traMADOL 25 mg Half Tablet 1 half tablet BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"00000Rx00000000033","type":"CDM"},{"code":"250","type":"RC"},{"code":"33","type":"NDC"}],"standard_charges":[{"gross_charge":0.25,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 HALF TABLET"}]},{"description":"spironolactone 12.5 mg Half Tablet 1 half tablet BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"00000Rx00000000034","type":"CDM"},{"code":"250","type":"RC"},{"code":"34","type":"NDC"}],"standard_charges":[{"gross_charge":0.25,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 HALF TABLET"}]},{"description":"warfarin 0.5 mg Half Tablet 1 half tablet BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"00000Rx00000000037","type":"CDM"},{"code":"250","type":"RC"},{"code":"37","type":"NDC"}],"standard_charges":[{"gross_charge":3.65,"discounted_cash":3.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 HALF TABLET"}]},{"description":"collagenase 250 unit/gram ointment 1.5 g Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"00000Rx00000000045","type":"CDM"},{"code":"250","type":"RC"},{"code":"45","type":"NDC"}],"standard_charges":[{"gross_charge":50.14,"discounted_cash":45.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 G"}]},{"description":"collagenase 250 unit/gram ointment 1 g Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"00000Rx00000000046","type":"CDM"},{"code":"250","type":"RC"},{"code":"46","type":"NDC"}],"standard_charges":[{"gross_charge":33.43,"discounted_cash":30.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"IRON SUCROSE 200 MG/100 ML NS IVPB 100 mL Bag","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"00000Rx00000000062","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1756","type":"HCPCS"},{"code":"62","type":"NDC"}],"standard_charges":[{"gross_charge":127.16,"discounted_cash":114.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"vancomycin 125 mg/2.5 mL solution 2.5 mL Syringe","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"00000Rx00000000066","type":"CDM"},{"code":"250","type":"RC"},{"code":"66","type":"NDC"}],"standard_charges":[{"gross_charge":0.38,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"ketamine in 0.9 % sod chloride 20 mg/2 mL (10 mg/mL) syringe 2 mL Syringe","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"00000Rx00000000071","type":"CDM"},{"code":"250","type":"RC"},{"code":"71","type":"NDC"}],"standard_charges":[{"gross_charge":0.92,"discounted_cash":0.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"vancomycin 125 mg/2.5 mL solution 5 mL Syringe","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"00000Rx00000000073","type":"CDM"},{"code":"250","type":"RC"},{"code":"73","type":"NDC"}],"standard_charges":[{"gross_charge":0.94,"discounted_cash":0.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"dexAMETHasone 12 mg/50 mL piggyback 50 mL Bag","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"00000Rx00000000080","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"80","type":"NDC"}],"standard_charges":[{"gross_charge":2.22,"discounted_cash":2.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"fentanyl in NS (PF) 10 mcg/mL solution 100 mL Bag","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"00000Rx00000000082","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"82","type":"NDC"}],"standard_charges":[{"gross_charge":174.58,"discounted_cash":157.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"HYDROmorphone 50 mg/50 mL solution 50 mL Bag","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"00000Rx00000000086","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1170","type":"HCPCS"},{"code":"86","type":"NDC"}],"standard_charges":[{"gross_charge":60.9,"discounted_cash":54.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"HYDROmorphone 50 mg/50 mL solution 50 mL Bag","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"00000Rx00000000086","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"86","type":"NDC"}],"standard_charges":[{"gross_charge":60.9,"discounted_cash":54.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"CISATRACURIUM 100 MG IN NS 100 ML INTRAVENOUS 100 mL 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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 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":3780.0,"discounted_cash":3402.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: FS 870 | 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":5875.0,"discounted_cash":5287.5,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: FS 870 | 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":3240.0,"discounted_cash":2916.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: FS 870 | 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":1830.0,"discounted_cash":1647.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: FS 870 | 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":4725.0,"discounted_cash":4252.5,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: FS 870 | 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":395.0,"discounted_cash":355.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: FS 870"}]},{"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":1700.0,"discounted_cash":1530.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: FS 870"}]},{"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":2900.0,"discounted_cash":2610.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: FS 870 | 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":2025.0,"discounted_cash":1822.5,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: FS 870 | 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":3645.0,"discounted_cash":3280.5,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: FS 870 | 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":2295.0,"discounted_cash":2065.5,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: FS 870 | 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":1900.0,"discounted_cash":1710.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: FS 870 | 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":3900.0,"discounted_cash":3510.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: FS 870 | 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":3400.0,"discounted_cash":3060.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: FS 870"}]},{"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":1635.0,"discounted_cash":1471.5,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: FS 870 | 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":3800.0,"discounted_cash":3420.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: FS 870 | 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":2700.0,"discounted_cash":2430.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: FS 870"}]},{"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":1500.0,"discounted_cash":1350.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: FS 870 | 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":1000.0,"discounted_cash":900.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: FS 870"}]},{"description":"Dop Echo Compl - 93320","code_information":[{"code":"12493320","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93320","type":"HCPCS"}],"standard_charges":[{"gross_charge":2935.0,"discounted_cash":2641.5,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: FS 870 | 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":1800.0,"discounted_cash":1620.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: FS 870 | 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":2000.0,"discounted_cash":1800.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: FS 870 | 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":3750.0,"discounted_cash":3375.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: FS 870 | 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":3000.0,"discounted_cash":2700.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: FS 870"}]},{"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":2300.0,"discounted_cash":2070.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: FS 870"}]},{"description":"HC Distal Protection Device Inse","code_information":[{"code":"12493799","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93799","type":"HCPCS"}],"standard_charges":[{"gross_charge":5000.0,"discounted_cash":4500.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: FS 870"}]},{"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":2160.0,"discounted_cash":1944.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: FS 870 | 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":1485.0,"discounted_cash":1336.5,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: FS 870 | 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":1455.0,"discounted_cash":1309.5,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: FS 870 | 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":2135.0,"discounted_cash":1921.5,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: FS 870 | 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":1470.0,"discounted_cash":1323.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: FS 870 | 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":2300.0,"discounted_cash":2070.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: FS 870 | 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":1500.0,"discounted_cash":1350.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: FS 870 | 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":2300.0,"discounted_cash":2070.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: FS 870 | 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":1200.0,"discounted_cash":1080.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: FS 870 | 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":2400.0,"discounted_cash":2160.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: FS 870 | 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":1500.0,"discounted_cash":1350.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: FS 870 | 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":2700.0,"discounted_cash":2430.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: FS 870 | 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":2230.0,"discounted_cash":2007.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: FS 870 | 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":2700.0,"discounted_cash":2430.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: FS 870 | 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 Uni/Lmtd - 93979","code_information":[{"code":"12493979","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93979","type":"HCPCS"}],"standard_charges":[{"gross_charge":2200.0,"discounted_cash":1980.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: FS 870 | 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 Duplex Scan Hemo Access Bilat","code_information":[{"code":"12493985","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93985","type":"HCPCS"}],"standard_charges":[{"gross_charge":1515.0,"discounted_cash":1363.5,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: FS 870 | 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 Duplex Scan Hemo Access Uni","code_information":[{"code":"12493986","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93986","type":"HCPCS"}],"standard_charges":[{"gross_charge":1200.0,"discounted_cash":1080.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: FS 870 | 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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