{"hospital_name":"Logan Health Medical Center","last_updated_on":"2026-04-01","version":"3.0.0","location_name":["Logan Health Medical Center"],"hospital_address":["310 Sunnyview Lane, Kalispell, MT 59901"],"license_information":{"license_number":"12869","state":"MT"},"type_2_npi":["1124007638"],"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":"Brigid Burke"},"modifier_information":[{"description":"Ambulatory surgical center (asc) facility service","code":"SG","modifier_payer_information":[{"payer_name":"6 Degrees of Health","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allegiance","plan_name":"MMIA & MACo Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allegiance","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allegiance","plan_name":"Preferred Provider Employers (Schools & Employer Groups) PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Logan Employee","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Logan Union Employee","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health","plan_name":"Administrators/WMI Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health","plan_name":"Aetna/Multiplan Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health","plan_name":"NW School District Consortium Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mountain Health Co-op","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacific Steel & Recycling","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"PacificSource","plan_name":"Billings Clinic Employee","description":"The modified price is presented in the standard charge value."},{"payer_name":"PacificSource","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare West","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"PPO","description":"The modified price is presented in the standard charge value."}]},{"description":"Bilateral Procedure","code":"50","modifier_payer_information":[{"payer_name":"6 Degrees of Health","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allegiance","plan_name":"MMIA & MACo Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allegiance","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allegiance","plan_name":"Preferred Provider Employers (Schools & Employer Groups) PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Logan Employee","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Logan Union Employee","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health","plan_name":"Administrators/WMI Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health","plan_name":"Aetna/Multiplan Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health","plan_name":"NW School District Consortium Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mountain Health Co-op","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacific Steel & Recycling","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"PacificSource","plan_name":"Billings Clinic Employee","description":"The modified price is presented in the standard charge value."},{"payer_name":"PacificSource","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare West","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"PPO","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":"6 Degrees of Health","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allegiance","plan_name":"MMIA & MACo Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allegiance","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allegiance","plan_name":"Preferred Provider Employers (Schools & Employer Groups) PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Logan Employee","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Logan Union Employee","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health","plan_name":"Administrators/WMI Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health","plan_name":"Aetna/Multiplan Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health","plan_name":"NW School District Consortium Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mountain Health Co-op","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacific Steel & Recycling","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"PacificSource","plan_name":"Billings Clinic Employee","description":"The modified price is presented in the standard charge value."},{"payer_name":"PacificSource","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare West","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"PPO","description":"The modified price is presented in the standard charge value."}]},{"description":"Reduced Services","code":"52","modifier_payer_information":[{"payer_name":"6 Degrees of Health","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allegiance","plan_name":"MMIA & MACo Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allegiance","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allegiance","plan_name":"Preferred Provider Employers (Schools & Employer Groups) PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Logan Employee","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Logan Union Employee","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health","plan_name":"Administrators/WMI Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health","plan_name":"Aetna/Multiplan Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health","plan_name":"NW School District Consortium Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mountain Health Co-op","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacific Steel & Recycling","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"PacificSource","plan_name":"Billings Clinic Employee","description":"The modified price is presented in the standard charge value."},{"payer_name":"PacificSource","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare West","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"PPO","description":"The modified price is presented in the standard charge value."}]},{"description":"Distinct Procedural Service","code":"59","modifier_payer_information":[{"payer_name":"6 Degrees of Health","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allegiance","plan_name":"MMIA & MACo Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allegiance","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allegiance","plan_name":"Preferred Provider Employers (Schools & Employer Groups) PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Logan Employee","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Logan Union Employee","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health","plan_name":"Administrators/WMI Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health","plan_name":"Aetna/Multiplan Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health","plan_name":"NW School District Consortium Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mountain Health Co-op","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacific Steel & Recycling","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"PacificSource","plan_name":"Billings Clinic Employee","description":"The modified price is presented in the standard charge value."},{"payer_name":"PacificSource","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare West","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"PPO","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":"6 Degrees of Health","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allegiance","plan_name":"MMIA & MACo Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allegiance","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allegiance","plan_name":"Preferred Provider Employers (Schools & Employer Groups) PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Logan Employee","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Logan Union Employee","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health","plan_name":"Administrators/WMI Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health","plan_name":"Aetna/Multiplan Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health","plan_name":"NW School District Consortium Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mountain Health Co-op","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacific Steel & Recycling","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"PacificSource","plan_name":"Billings Clinic Employee","description":"The modified price is presented in the standard charge value."},{"payer_name":"PacificSource","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare West","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"PPO","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":"6 Degrees of Health","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allegiance","plan_name":"MMIA & MACo Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allegiance","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allegiance","plan_name":"Preferred Provider Employers (Schools & Employer Groups) PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Logan Employee","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Logan Union Employee","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health","plan_name":"Administrators/WMI Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health","plan_name":"Aetna/Multiplan Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health","plan_name":"NW School District Consortium Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mountain Health Co-op","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacific Steel & Recycling","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"PacificSource","plan_name":"Billings Clinic Employee","description":"The modified price is presented in the standard charge value."},{"payer_name":"PacificSource","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare West","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"PPO","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":"6 Degrees of Health","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allegiance","plan_name":"MMIA & MACo Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allegiance","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allegiance","plan_name":"Preferred Provider Employers (Schools & Employer Groups) PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Logan Employee","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Logan Union Employee","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health","plan_name":"Administrators/WMI Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health","plan_name":"Aetna/Multiplan Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health","plan_name":"NW School District Consortium Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mountain Health Co-op","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacific Steel & Recycling","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"PacificSource","plan_name":"Billings Clinic Employee","description":"The modified price is presented in the standard charge value."},{"payer_name":"PacificSource","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare West","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"PPO","description":"The modified price is presented in the standard charge value."}]},{"description":"Professional Component","code":"26","modifier_payer_information":[{"payer_name":"6 Degrees of Health","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allegiance","plan_name":"MMIA & MACo Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allegiance","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allegiance","plan_name":"Preferred Provider Employers (Schools & Employer Groups) PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Logan Employee","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Logan Union Employee","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health","plan_name":"Administrators/WMI Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health","plan_name":"Aetna/Multiplan Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health","plan_name":"NW School District Consortium Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mountain Health Co-op","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacific Steel & Recycling","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"PacificSource","plan_name":"Billings Clinic Employee","description":"The modified price is presented in the standard charge value."},{"payer_name":"PacificSource","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare West","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"PPO","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":"6 Degrees of Health","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allegiance","plan_name":"MMIA & MACo Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allegiance","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allegiance","plan_name":"Preferred Provider Employers (Schools & Employer Groups) PPO","description":"The modified price is presented in the standard charge 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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":"NDL ELECTROMYOGRAPHY, LARYNX","code_information":[{"code":"92295865T","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95865","type":"CPT"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":111.8,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"NDL ELECTROMYOGRAPHY, HEMIDIAP","code_information":[{"code":"92295866T","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95866","type":"CPT"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":105.3,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"NDL ELECTROMYOGRAPHY, CRNL NRV","code_information":[{"code":"92295867T","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95867","type":"CPT"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":104.65,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"MUSCLE TEST CRAN NERVE, BILAT","code_information":[{"code":"92295868F","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95868","type":"CPT"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":110.5,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"MUSCLE TST, THORACIC PARASPIN","code_information":[{"code":"92295869F","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95869","type":"CPT"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":109.2,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"MUSCLE TST, NON THOR PARASPIN","code_information":[{"code":"92295870F","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95870","type":"CPT"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":104.65,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"NDL EMG W/1 FIBER ELEC, QUANT","code_information":[{"code":"92295872T","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95872","type":"CPT"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":96.2,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"GUIDE NERV DESTR ELEC STIM","code_information":[{"code":"92295873F","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95873","type":"CPT"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":81.25,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"NDL EMG FOR GUID W/CHEMONERV","code_information":[{"code":"92295874F","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95874","type":"CPT"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":83.85,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"MUSCLE TEST W/NERVE TEST LTD","code_information":[{"code":"92295885F","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95885","type":"CPT"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":62.4,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"MUSCLE TEST W/NERVE TEST, COMP","code_information":[{"code":"92295886F","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95886","type":"CPT"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":70.85,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"MUSCLE TST W/NERVE, NON EXTRE","code_information":[{"code":"92295887F","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95887","type":"CPT"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":65.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"MOTOR/SENSORY NERVE COND TEST","code_information":[{"code":"92295905F","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95905","type":"CPT"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":89.7,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"NERVE COND STUDIES, 1-2 STUDI","code_information":[{"code":"92295907F","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95907","type":"CPT"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":62.4,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"NERVE COND STUDIES, 3-4 STUDI","code_information":[{"code":"92295908F","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95908","type":"CPT"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":83.2,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"NERVE COND STUDIES, 5-6 STUDI","code_information":[{"code":"92295909F","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95909","type":"CPT"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":98.8,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"NERVE COND STUDIES, 7-8 STUDI","code_information":[{"code":"92295910F","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95910","type":"CPT"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":127.4,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"NERVE COND STUDIES, 9-10 STUD","code_information":[{"code":"92295911F","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95911","type":"CPT"}],"standard_charges":[{"gross_charge":224.0,"discounted_cash":145.6,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"NERVE COND STUDIES, 11-12 STU","code_information":[{"code":"92295912F","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95912","type":"CPT"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":150.15,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"NERVE COND STUDIES, 13 OR MOR","code_information":[{"code":"92295913F","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95913","type":"CPT"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":166.4,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"ANS PARSYMP & SYMP TEST W/TILT","code_information":[{"code":"92295924F","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95924","type":"CPT"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":89.05,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"SSEP (SOMATOSENSORY)","code_information":[{"code":"92295925","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95925","type":"CPT"}],"standard_charges":[{"gross_charge":1341.5,"discounted_cash":871.98,"setting":"both","billing_class":"facility"}]},{"description":"SOMATOSENS TEST, UPPER LIMBS","code_information":[{"code":"92295925F","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95925","type":"CPT"}],"standard_charges":[{"gross_charge":236.0,"discounted_cash":153.4,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"SOMATOSENS TEST, LOWER LIMBS","code_information":[{"code":"92295926F","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95926","type":"CPT"}],"standard_charges":[{"gross_charge":227.0,"discounted_cash":147.55,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"VISUAL EVOKED POTENTIAL TEST","code_information":[{"code":"92295930F","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95930","type":"CPT"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":72.8,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"BLINK REFLEX TEST","code_information":[{"code":"92295933T","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95933","type":"CPT"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":83.85,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"NEUROMUSCULAR JUNCTION TEST","code_information":[{"code":"92295937F","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95937","type":"CPT"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":78.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"ALLG TSTG PERQ & IC W/VENOMS","code_information":[{"code":"92495017F","type":"CDM"},{"code":"0924","type":"RC"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":11.05,"setting":"both","billing_class":"facility"}]},{"description":"PERQ & IC ALLG TEST RX/BIOL","code_information":[{"code":"92495018F","type":"CDM"},{"code":"0924","type":"RC"},{"code":"95018","type":"CPT"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":27.3,"setting":"both","billing_class":"facility"}]},{"description":"INGEST CHALLENGE;INTL 120 MIN","code_information":[{"code":"92495076","type":"CDM"},{"code":"0924","type":"RC"},{"code":"95076","type":"CPT"}],"standard_charges":[{"gross_charge":512.25,"discounted_cash":332.96,"setting":"both","billing_class":"facility"}]},{"description":"INJ PLATELET PLASMA W/IMG","code_information":[{"code":"9290232T","type":"CDM"},{"code":"0490","type":"RC"}],"standard_charges":[{"gross_charge":2075.5,"discounted_cash":1349.08,"setting":"both","billing_class":"facility"}]},{"description":"DRAINAGE OF SKIN ABSCESS,SMPL","code_information":[{"code":"92910060","type":"CDM"},{"code":"0490","type":"RC"},{"code":"10060","type":"CPT"}],"standard_charges":[{"gross_charge":455.75,"discounted_cash":296.24,"setting":"both","modifier_code":["SG"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier SG: Ambulatory surgical center (asc) facility service"}]},{"description":"DRAINAGE OF SKIN ABSCESS,MULT","code_information":[{"code":"92910061","type":"CDM"},{"code":"0490","type":"RC"},{"code":"10061","type":"CPT"}],"standard_charges":[{"gross_charge":853.0,"discounted_cash":554.45,"setting":"both","modifier_code":["SG"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier SG: Ambulatory surgical center (asc) facility service"}]},{"description":"I&D PILONIDAL CYST, SMPL","code_information":[{"code":"92910080","type":"CDM"},{"code":"0490","type":"RC"},{"code":"10080","type":"CPT"}],"standard_charges":[{"gross_charge":511.75,"discounted_cash":332.64,"setting":"both","modifier_code":["SG"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier SG: Ambulatory surgical center (asc) facility service"}]},{"description":"SQ FB REMOVL/W INCIS/SIMP","code_information":[{"code":"92910120","type":"CDM"},{"code":"0490","type":"RC"},{"code":"10120","type":"CPT"}],"standard_charges":[{"gross_charge":1042.25,"discounted_cash":677.46,"setting":"both","modifier_code":["SG"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier SG: Ambulatory surgical center (asc) facility service"}]},{"description":"SQ FB REMOVL/W INCIS/COMP","code_information":[{"code":"92910121","type":"CDM"},{"code":"0490","type":"RC"},{"code":"10121","type":"CPT"}],"standard_charges":[{"gross_charge":2043.5,"discounted_cash":1328.28,"setting":"both","modifier_code":["SG"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier SG: Ambulatory surgical center (asc) facility service"}]},{"description":"I&D HEMATOMA/SEROMA/FLUID","code_information":[{"code":"92910140","type":"CDM"},{"code":"0490","type":"RC"},{"code":"10140","type":"CPT"}],"standard_charges":[{"gross_charge":1293.0,"discounted_cash":840.45,"setting":"both","modifier_code":["SG"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier SG: Ambulatory surgical center (asc) facility service"}]},{"description":"DRAINAGE OF HEMATOMA/FLUID","code_information":[{"code":"92910160","type":"CDM"},{"code":"0490","type":"RC"},{"code":"10160","type":"CPT"}],"standard_charges":[{"gross_charge":396.25,"discounted_cash":257.56,"setting":"both","modifier_code":["SG"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier SG: Ambulatory surgical center (asc) facility service"}]},{"description":"WND INCISION & DRAINAGE CMPLX","code_information":[{"code":"92910180","type":"CDM"},{"code":"0490","type":"RC"},{"code":"10180","type":"CPT"}],"standard_charges":[{"gross_charge":2820.5,"discounted_cash":1833.32,"setting":"both","modifier_code":["SG"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier SG: Ambulatory surgical center (asc) facility service"}]},{"description":"DEBRIDE INFECTED SKIN","code_information":[{"code":"92911000","type":"CDM"},{"code":"0490","type":"RC"},{"code":"11000","type":"CPT"}],"standard_charges":[{"gross_charge":550.5,"discounted_cash":357.82,"setting":"both","modifier_code":["SG"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier SG: Ambulatory surgical center (asc) facility service"}]},{"description":"DEBRIDE SKIN AT FX SITE","code_information":[{"code":"92911010","type":"CDM"},{"code":"0490","type":"RC"},{"code":"11010","type":"CPT"}],"standard_charges":[{"gross_charge":1210.75,"discounted_cash":786.99,"setting":"both","modifier_code":["SG"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier SG: Ambulatory surgical center (asc) facility service"}]},{"description":"DEBRIDE SKIN MUSC AT FX SITE","code_information":[{"code":"92911011","type":"CDM"},{"code":"0490","type":"RC"},{"code":"11011","type":"CPT"}],"standard_charges":[{"gross_charge":908.0,"discounted_cash":590.2,"setting":"both","modifier_code":["SG"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier SG: Ambulatory surgical center (asc) facility service"}]},{"description":"DEB SKIN BONE AT FX SITE","code_information":[{"code":"92911012","type":"CDM"},{"code":"0490","type":"RC"},{"code":"11012","type":"CPT"}],"standard_charges":[{"gross_charge":1858.75,"discounted_cash":1208.19,"setting":"both","modifier_code":["SG"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier SG: Ambulatory surgical center (asc) facility service"}]},{"description":"DEB SUBQ TIS 20 SQ CM/<","code_information":[{"code":"92911042","type":"CDM"},{"code":"0490","type":"RC"},{"code":"11042","type":"CPT"}],"standard_charges":[{"gross_charge":519.5,"discounted_cash":337.68,"setting":"both","modifier_code":["SG"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier SG: Ambulatory surgical center (asc) facility service"}]},{"description":"DEB MUSC/FASCIA 20 SQ CM/<","code_information":[{"code":"92911043","type":"CDM"},{"code":"0490","type":"RC"},{"code":"11043","type":"CPT"}],"standard_charges":[{"gross_charge":550.5,"discounted_cash":357.82,"setting":"both","modifier_code":["SG"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier SG: Ambulatory surgical center (asc) facility service"}]},{"description":"DEB BONE 20 SQ 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presented in the standard charge value. | Modifier SG: Ambulatory surgical center (asc) facility service"}]},{"description":"COLONOSCOPY","code_information":[{"code":"92945381","type":"CDM"},{"code":"0490","type":"RC"},{"code":"45381","type":"CPT"}],"standard_charges":[{"gross_charge":1858.75,"discounted_cash":1208.19,"setting":"both","modifier_code":["SG"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier SG: Ambulatory surgical center (asc) facility service"}]},{"description":"COLONOSCOPY CONTROL/BLEEDING","code_information":[{"code":"92945382","type":"CDM"},{"code":"0490","type":"RC"},{"code":"45382","type":"CPT"}],"standard_charges":[{"gross_charge":1811.5,"discounted_cash":1177.48,"setting":"both","modifier_code":["SG"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier SG: Ambulatory surgical center (asc) facility 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presented in the standard charge value. | Modifier SG: Ambulatory surgical center (asc) facility service"}]},{"description":"INJ NERVE BLOCK","code_information":[{"code":"92964421","type":"CDM"},{"code":"0490","type":"RC"},{"code":"64421","type":"CPT"}],"standard_charges":[{"gross_charge":1790.5,"discounted_cash":1163.82,"setting":"both","modifier_code":["SG"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier SG: Ambulatory surgical center (asc) facility service"}]},{"description":"INJ AA&/STRD ILIOINGUL IH NRV","code_information":[{"code":"92964425","type":"CDM"},{"code":"0490","type":"RC"},{"code":"64425","type":"CPT"}],"standard_charges":[{"gross_charge":1675.25,"discounted_cash":1088.91,"setting":"both","modifier_code":["SG"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier SG: Ambulatory surgical center (asc) facility 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":18265.99,"maximum":44751.68,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":44751.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44751.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18265.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18996.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18265.99,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Degenerative Nervous System Disorders Without Mcc","code_information":[{"code":"057","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":10456.4,"maximum":25618.18,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25618.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25618.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10456.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10874.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10456.4,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Mcc","code_information":[{"code":"058","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":13964.83,"maximum":34213.83,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34213.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34213.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13964.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14523.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13964.83,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","code_information":[{"code":"063","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":47641.94,"10th_percentile":47641.94,"90th_percentile":47641.94},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13749.01,"10th_percentile":15.8,"90th_percentile":15467.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15257.02,"10th_percentile":15257.02,"90th_percentile":15257.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"1 through 10","median_amount":16.0,"10th_percentile":16.0,"90th_percentile":16.0}]},{"setting":"inpatient","billing_class":"facility","minimum":15893.85,"maximum":38939.93,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":38939.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38939.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15893.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16529.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15893.85,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","code_information":[{"code":"065","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":19706.97,"10th_percentile":19706.97,"90th_percentile":19706.97},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7283.8,"10th_percentile":15.96,"90th_percentile":7882.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":17011.74,"10th_percentile":25.24,"90th_percentile":47045.3},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7.9,"10th_percentile":7.9,"90th_percentile":7165.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":8287.96,"maximum":20305.50,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20305.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20305.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8287.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8619.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8287.96,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","code_information":[{"code":"066","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1866.35,"10th_percentile":7.6,"90th_percentile":3873.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7.91,"10th_percentile":7.91,"90th_percentile":7.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":11772.06,"maximum":28841.55,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28841.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28841.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11772.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12242.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11772.06,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Precerebral Occlusion Without Infarction Without Mcc","code_information":[{"code":"068","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5739.04,"10th_percentile":5739.04,"90th_percentile":5739.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":7179.04,"maximum":17588.65,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17588.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17588.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7179.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7466.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7179.04,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Transient Ischemia Without Thrombolytic","code_information":[{"code":"069","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2492.22,"10th_percentile":2492.22,"90th_percentile":2492.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":13262.53,"maximum":32493.20,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32493.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32493.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13262.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13793.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13262.53,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Cerebrovascular Disorders With Cc","code_information":[{"code":"071","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":47540.1,"10th_percentile":47540.1,"90th_percentile":47540.1},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7.9,"10th_percentile":7.9,"90th_percentile":7.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy With Cc","code_information":[{"code":"078","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3634.42,"10th_percentile":3634.42,"90th_percentile":3634.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy Without Cc/Mcc","code_information":[{"code":"079","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nontraumatic Stupor And Coma With Mcc","code_information":[{"code":"080","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":14366.14,"maximum":35197.04,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35197.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35197.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14366.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14940.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14366.14,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Nontraumatic Stupor And Coma Without Mcc","code_information":[{"code":"081","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":7416.18,"maximum":18169.64,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18169.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18169.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7416.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7712.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7416.18,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Mcc","code_information":[{"code":"082","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"1 through 10","median_amount":17835.66,"10th_percentile":17835.66,"90th_percentile":17859.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8607.17,"10th_percentile":8607.17,"90th_percentile":8607.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":17980.97,"maximum":44053.38,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":44053.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44053.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17980.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18700.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17980.97,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Cc","code_information":[{"code":"083","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":10239.09,"10th_percentile":10239.09,"90th_percentile":10239.09},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1970.01,"10th_percentile":1970.01,"90th_percentile":1970.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":11217.98,"maximum":27484.05,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27484.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27484.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11217.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11666.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11217.98,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","code_information":[{"code":"084","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":10510.37,"maximum":25750.41,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25750.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25750.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10510.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10930.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10510.37,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","code_information":[{"code":"087","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8.13,"10th_percentile":8.13,"90th_percentile":8.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":14843.48,"10th_percentile":14843.48,"90th_percentile":14843.48},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":7561.35,"maximum":18525.31,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18525.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18525.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7561.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7863.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7561.35,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Concussion With Mcc","code_information":[{"code":"088","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":18051.65,"maximum":44226.54,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":44226.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44226.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18051.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18773.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18051.65,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","code_information":[{"code":"099","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":15329.89,"maximum":37558.23,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37558.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37558.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15329.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15943.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15329.89,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Seizures Without Mcc","code_information":[{"code":"101","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":6929.22,"10th_percentile":12.62,"90th_percentile":17201.74},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2530.45,"10th_percentile":15.36,"90th_percentile":6492.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"1 through 10","median_amount":7327.96,"10th_percentile":7327.96,"90th_percentile":7327.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7605.48,"10th_percentile":7605.48,"90th_percentile":7605.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"1 through 10","median_amount":30327.27,"10th_percentile":30327.27,"90th_percentile":30327.27}]},{"setting":"inpatient","billing_class":"facility","minimum":7469.38,"maximum":18299.98,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18299.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18299.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7469.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7768.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7469.38,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Headaches With Mcc","code_information":[{"code":"102","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":9450.85,"maximum":23154.58,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23154.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23154.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9450.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9828.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9450.85,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Acute Major Eye Infections Without Cc/Mcc","code_information":[{"code":"122","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":6581.64,"maximum":16125.02,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16125.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16125.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6581.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6844.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6581.64,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Neurological Eye Disorders","code_information":[{"code":"123","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"1 through 10","median_amount":6445.91,"10th_percentile":6445.91,"90th_percentile":6445.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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Procedures W Cc/Mcc","code_information":[{"code":"133","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures With Mcc","code_information":[{"code":"163","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":74341.93,"10th_percentile":74341.93,"90th_percentile":74341.93},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33496.15,"10th_percentile":33496.15,"90th_percentile":33496.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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Procedures Without Cc/Mcc","code_information":[{"code":"168","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":23882.88,"10th_percentile":23882.88,"90th_percentile":23882.88},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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Procedures w/o CC","code_information":[{"code":"171","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","code_information":[{"code":"175","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5942.95,"10th_percentile":5942.95,"90th_percentile":11091.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":57445.44,"10th_percentile":57445.44,"90th_percentile":57445.44},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":11049.25,"maximum":27070.66,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27070.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27070.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11049.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11491.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11049.25,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Pulmonary Embolism Without Mcc","code_information":[{"code":"176","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8.13,"10th_percentile":8.13,"90th_percentile":6291.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7.84,"10th_percentile":7.84,"90th_percentile":7.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"1 through 10","median_amount":16.0,"10th_percentile":16.0,"90th_percentile":16.0}]},{"setting":"inpatient","billing_class":"facility","minimum":6727.57,"maximum":16482.55,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16482.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16482.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6727.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6996.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6727.57,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Respiratory Infections And Inflammations With Mcc","code_information":[{"code":"177","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10208.21,"10th_percentile":7.6,"90th_percentile":12316.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":3161.96,"10th_percentile":7.68,"90th_percentile":12216.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"1 through 10","median_amount":52383.02,"10th_percentile":52383.02,"90th_percentile":52383.02}]},{"setting":"inpatient","billing_class":"facility","minimum":12486.52,"maximum":30591.97,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30591.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30591.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12486.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12985.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12486.52,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Respiratory Infections And Inflammations With Cc","code_information":[{"code":"178","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6908.08,"10th_percentile":6908.08,"90th_percentile":6908.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":8027.26,"maximum":19666.79,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19666.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19666.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8027.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8348.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8027.26,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Respiratory Infections And Inflammations Without Cc/Mcc","code_information":[{"code":"179","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":6347.54,"maximum":15551.47,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15551.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15551.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6347.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6347.54,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Respiratory Neoplasms With Mcc","code_information":[{"code":"180","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"1 through 10","median_amount":9692.71,"10th_percentile":9692.71,"90th_percentile":9692.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10.55,"10th_percentile":10.55,"90th_percentile":7025.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":9998.85,"maximum":24497.18,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24497.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24497.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9998.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10398.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9998.85,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Mcc","code_information":[{"code":"190","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":22075.2,"10th_percentile":22075.2,"90th_percentile":22075.2},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":15.2,"10th_percentile":7.6,"90th_percentile":8224.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":19034.07,"10th_percentile":19034.07,"90th_percentile":19034.07},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"24","median_amount":936.41,"10th_percentile":7.68,"90th_percentile":7362.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":29196.16,"10th_percentile":29196.16,"90th_percentile":29196.16},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":7615.01,"10th_percentile":7615.01,"90th_percentile":7615.01},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":9936.96,"10th_percentile":9936.96,"90th_percentile":13191.58},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":7797.75,"10th_percentile":7.6,"90th_percentile":9635.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"15","median_amount":11787.07,"10th_percentile":12.62,"90th_percentile":32362.63},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"36","median_amount":6679.66,"10th_percentile":7.68,"90th_percentile":9443.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":11515.6,"10th_percentile":10574.46,"90th_percentile":14140.5},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"17","median_amount":23.52,"10th_percentile":7.84,"90th_percentile":10623.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"1 through 10","median_amount":12797.93,"10th_percentile":12797.93,"90th_percentile":12797.93}]},{"setting":"inpatient","billing_class":"facility","minimum":10599.29,"maximum":25968.26,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25968.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25968.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10599.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11023.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10599.29,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Simple Pneumonia And Pleurisy With Cc","code_information":[{"code":"194","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7.82,"10th_percentile":7.76,"90th_percentile":6395.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":6769.79,"10th_percentile":12.62,"90th_percentile":21972.46},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7.9,"10th_percentile":7.9,"90th_percentile":6694.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"1 through 10","median_amount":6580.88,"10th_percentile":6580.88,"90th_percentile":6580.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6779.59,"10th_percentile":6779.59,"90th_percentile":6779.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":6734.41,"maximum":16499.30,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16499.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16499.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6734.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7003.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6734.41,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Simple Pneumonia And Pleurisy Without Cc/Mcc","code_information":[{"code":"195","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23.52,"10th_percentile":23.52,"90th_percentile":13209.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":14952.9,"maximum":36634.60,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":36634.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36634.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14952.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15551.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14952.9,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Interstitial Lung Disease With Cc","code_information":[{"code":"197","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":7822.81,"maximum":19165.88,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19165.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19165.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7822.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8135.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7822.81,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Interstitial Lung Disease Without Cc/Mcc","code_information":[{"code":"198","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":6052.64,"maximum":14828.97,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14828.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14828.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6052.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6294.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6052.64,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Pneumothorax With Mcc","code_information":[{"code":"199","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12061.46,"10th_percentile":8.13,"90th_percentile":12064.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"1 through 10","median_amount":13706.68,"10th_percentile":13706.68,"90th_percentile":13706.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14041.4,"10th_percentile":14041.4,"90th_percentile":14041.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":14017.27,"maximum":34342.31,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34342.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34342.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14017.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14577.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14017.27,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Pneumothorax With Cc","code_information":[{"code":"200","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7.9,"10th_percentile":7.9,"90th_percentile":7.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":10862.6,"10th_percentile":10775.91,"90th_percentile":11780.17},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2309.45,"10th_percentile":2309.45,"90th_percentile":2309.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":13912.53,"10th_percentile":13912.53,"90th_percentile":13912.53},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":7990.78,"maximum":19577.41,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19577.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19577.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7990.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8310.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7990.78,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Bronchitis And Asthma Without Cc/Mcc","code_information":[{"code":"203","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":4167.9,"10th_percentile":4167.9,"90th_percentile":4167.9},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":5353.63,"10th_percentile":5353.63,"90th_percentile":5353.63},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":14525.75,"maximum":35588.09,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35588.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35588.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14525.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15106.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14525.75,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Respiratory System Diagnoses Without Mcc","code_information":[{"code":"206","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":3597.26,"10th_percentile":3597.26,"90th_percentile":3597.26},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":5975.37,"10th_percentile":5975.37,"90th_percentile":5975.37},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1024.71,"10th_percentile":1024.71,"90th_percentile":1024.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18307.69,"10th_percentile":18307.69,"90th_percentile":18307.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":46265.6,"10th_percentile":46265.6,"90th_percentile":46265.6},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":21500.79,"maximum":52676.94,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":52676.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52676.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21500.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22360.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21500.79,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Complex Aortic Arch Procedures","code_information":[{"code":"209","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":58716.96,"maximum":143856.55,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":143856.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":143856.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58716.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61065.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58716.96,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","code_information":[{"code":"234","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":25.24,"10th_percentile":11.51,"90th_percentile":203857.13},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37150.5,"10th_percentile":46.09,"90th_percentile":38855.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16.12,"10th_percentile":16.12,"90th_percentile":41391.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":63538.06,"10th_percentile":63538.06,"90th_percentile":63538.06},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15735.79,"10th_percentile":7.91,"90th_percentile":16768.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":16805.16,"maximum":41172.64,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":41172.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41172.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16805.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17477.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16805.16,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","code_information":[{"code":"244","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11572.14,"10th_percentile":11572.14,"90th_percentile":11572.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22.43,"10th_percentile":7.91,"90th_percentile":13024.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"1 through 10","median_amount":13905.47,"10th_percentile":13905.47,"90th_percentile":13905.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":14347.13,"maximum":35150.47,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35150.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35150.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14347.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14921.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14347.13,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Aicd Generator Procedures","code_information":[{"code":"245","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15.68,"10th_percentile":15.68,"90th_percentile":38020.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":35285.94,"maximum":86450.55,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":86450.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":86450.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35285.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36697.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35285.94,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","code_information":[{"code":"246","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":25999.56,"maximum":63698.92,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":63698.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":63698.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25999.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27039.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25999.56,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Aicd Lead Procedures","code_information":[{"code":"265","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":28109.48,"maximum":68868.23,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":68868.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":68868.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28109.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29233.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28109.48,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","code_information":[{"code":"266","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":83406.87,"10th_percentile":83406.87,"90th_percentile":83406.87},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"1 through 10","median_amount":15.96,"10th_percentile":7.98,"90th_percentile":45228.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":47188.42,"maximum":115611.63,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":115611.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":115611.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47188.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49075.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47188.42,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","code_information":[{"code":"267","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"1 through 10","median_amount":35534.85,"10th_percentile":23.94,"90th_percentile":35630.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":36793.89,"maximum":90145.03,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":90145.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":90145.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36793.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38265.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36793.89,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","code_information":[{"code":"268","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":25627.9,"maximum":62788.36,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":62788.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62788.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25627.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26653.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25627.9,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","code_information":[{"code":"275","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":52677.36,"10th_percentile":52677.36,"90th_percentile":52677.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15.68,"10th_percentile":15.68,"90th_percentile":11345.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":12801.18,"maximum":31362.89,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31362.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31362.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12801.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13313.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12801.18,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Cc","code_information":[{"code":"281","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":18264.49,"10th_percentile":18264.49,"90th_percentile":18264.49},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":30612.21,"10th_percentile":30612.21,"90th_percentile":30612.21},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6370.34,"10th_percentile":15.36,"90th_percentile":6734.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":23503.66,"10th_percentile":23503.66,"90th_percentile":23503.66},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2475.83,"10th_percentile":2475.83,"90th_percentile":2475.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":7594.79,"maximum":18607.24,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18607.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18607.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7594.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7898.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7594.79,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","code_information":[{"code":"282","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5346.81,"10th_percentile":5346.81,"90th_percentile":5346.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":34305.65,"10th_percentile":34305.65,"90th_percentile":34305.65},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8459.43,"10th_percentile":16.12,"90th_percentile":8728.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":8742.48,"maximum":21419.08,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21419.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21419.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8742.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9092.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8742.48,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Acute And Subacute Endocarditis With Mcc","code_information":[{"code":"288","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":24920.53,"10th_percentile":25.24,"90th_percentile":33610.41},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"43","median_amount":16.26,"10th_percentile":7.68,"90th_percentile":10094.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":10366.72,"maximum":25398.46,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25398.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25398.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10366.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10781.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10366.72,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Heart Failure And Shock With Cc","code_information":[{"code":"292","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":7061.99,"maximum":17301.88,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17301.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17301.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7061.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7344.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7061.99,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Heart Failure And Shock Without Cc/Mcc","code_information":[{"code":"293","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":5725.81,"maximum":14028.23,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14028.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14028.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5725.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5954.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5725.81,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Hypertension With Mcc","code_information":[{"code":"304","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"1 through 10","median_amount":9216.83,"10th_percentile":9216.83,"90th_percentile":9216.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":9653.78,"maximum":23651.76,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23651.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23651.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9653.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10039.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9653.78,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Hypertension Without Mcc","code_information":[{"code":"305","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":15234.33,"10th_percentile":15234.33,"90th_percentile":15234.33},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5562.58,"10th_percentile":5562.58,"90th_percentile":5562.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":6348.3,"maximum":15553.34,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15553.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15553.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6348.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6602.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6348.3,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Cardiac Congenital And Valvular Disorders With Mcc","code_information":[{"code":"306","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":12586.08,"maximum":30835.90,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30835.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30835.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12586.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13089.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12586.08,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Cardiac Congenital And Valvular Disorders Without Mcc","code_information":[{"code":"307","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3914.06,"10th_percentile":15.8,"90th_percentile":8443.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":8400.05,"10th_percentile":8400.05,"90th_percentile":8400.05},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":5753.57,"10th_percentile":50.48,"90th_percentile":21983.65},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1241.36,"10th_percentile":15.8,"90th_percentile":5358.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":193.39,"10th_percentile":15.8,"90th_percentile":4541.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":5635.68,"10th_percentile":5635.68,"90th_percentile":5635.68},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1905.03,"10th_percentile":16.12,"90th_percentile":3995.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":4911.79,"maximum":12033.89,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12033.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12033.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4911.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5108.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4911.79,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Angina Pectoris","code_information":[{"code":"311","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5605.66,"10th_percentile":5605.66,"90th_percentile":5605.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":7233.76,"maximum":17722.71,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17722.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17722.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7233.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7523.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7233.76,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Chest Pain","code_information":[{"code":"313","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":22.72,"10th_percentile":22.72,"90th_percentile":22.72},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2962.29,"10th_percentile":2962.29,"90th_percentile":2962.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":22131.6,"10th_percentile":22131.6,"90th_percentile":22131.6},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15480.87,"10th_percentile":15480.87,"90th_percentile":15480.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":128621.23,"10th_percentile":128621.23,"90th_percentile":128621.23},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15734.55,"10th_percentile":15734.55,"90th_percentile":15734.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":16457.81,"maximum":40321.63,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40321.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40321.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16457.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17116.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16457.81,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Circulatory System Diagnoses With Cc","code_information":[{"code":"315","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6339.3,"10th_percentile":6339.3,"90th_percentile":6339.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":6402.43,"10th_percentile":20.2,"90th_percentile":10491.96},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":10226.08,"10th_percentile":10226.08,"90th_percentile":10226.08},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":57140.85,"10th_percentile":57140.85,"90th_percentile":57140.85},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21477.3,"10th_percentile":21477.3,"90th_percentile":21477.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":21288.73,"maximum":52157.39,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":52157.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52157.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21288.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22140.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21288.73,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","code_information":[{"code":"322","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13172.75,"10th_percentile":13172.75,"90th_percentile":13172.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":65013.41,"10th_percentile":10.73,"90th_percentile":79027.92},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"15","median_amount":23.7,"10th_percentile":7.9,"90th_percentile":13754.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":49094.57,"10th_percentile":99.05,"90th_percentile":62253.55},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":14008.91,"maximum":34321.83,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34321.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34321.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14008.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14569.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14008.91,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","code_information":[{"code":"323","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32059.76,"10th_percentile":32059.76,"90th_percentile":32059.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":150229.95,"10th_percentile":150229.95,"90th_percentile":150229.95},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":74829.39,"10th_percentile":74829.39,"90th_percentile":80068.34},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":77892.33,"10th_percentile":77892.33,"90th_percentile":77892.33},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":22157.56,"10th_percentile":22157.56,"90th_percentile":22157.56},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":55409.9,"10th_percentile":55409.9,"90th_percentile":55409.9},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":34030.13,"10th_percentile":34030.13,"90th_percentile":34030.13},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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Procedures","code_information":[{"code":"365","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":12708.45,"maximum":31135.70,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31135.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31135.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12708.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13216.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12708.45,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Major Esophageal Disorders With Cc","code_information":[{"code":"369","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7454.98,"10th_percentile":7454.98,"90th_percentile":7454.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5388.75,"10th_percentile":7.68,"90th_percentile":11553.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":23497.83,"10th_percentile":23497.83,"90th_percentile":23497.83},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2398.94,"10th_percentile":7.68,"90th_percentile":6941.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6774.94,"10th_percentile":8.06,"90th_percentile":7181.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":8062.99,"maximum":19754.33,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19754.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19754.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8062.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8385.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8062.99,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Gastrointestinal Hemorrhage Without Cc/Mcc","code_information":[{"code":"379","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":5400.51,"maximum":13231.25,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13231.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13231.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5400.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5616.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5400.51,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Complicated Peptic Ulcer With Mcc","code_information":[{"code":"380","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":53104.37,"10th_percentile":53104.37,"90th_percentile":53104.37},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":15522.94,"maximum":38031.20,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":38031.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38031.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15522.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16143.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15522.94,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Complicated Peptic Ulcer With Cc","code_information":[{"code":"381","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8503.81,"10th_percentile":8503.81,"90th_percentile":8503.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":8844.32,"maximum":21668.58,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21668.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21668.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8844.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9198.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8844.32,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Complicated Peptic Ulcer Without Cc/Mcc","code_information":[{"code":"382","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":10426.41,"10th_percentile":10426.41,"90th_percentile":10426.41},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":100546.24,"10th_percentile":100546.24,"90th_percentile":100546.24},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10195.82,"10th_percentile":10195.82,"90th_percentile":10195.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":13611.68,"10th_percentile":12.62,"90th_percentile":39555.07},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8.13,"10th_percentile":8.13,"90th_percentile":5666.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":12046.27,"10th_percentile":12.62,"90th_percentile":22638.7},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4944.41,"10th_percentile":15.36,"90th_percentile":6517.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":31874.84,"10th_percentile":31874.84,"90th_percentile":31874.84},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6411.71,"10th_percentile":6411.71,"90th_percentile":6411.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":7720.96,"maximum":18916.35,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18916.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18916.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7720.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8029.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7720.96,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Digestive System Diagnoses Without Cc/Mcc","code_information":[{"code":"395","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":15495.44,"10th_percentile":15495.44,"90th_percentile":15495.44},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"1 through 10","median_amount":5253.94,"10th_percentile":5253.94,"90th_percentile":5253.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":5541.88,"maximum":13577.61,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13577.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13577.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5541.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5763.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5541.88,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Red Blood Cell Disorders Age 0-17","code_information":[{"code":"396","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures With Mcc","code_information":[{"code":"397","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":18811.71,"maximum":46088.69,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":46088.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46088.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18811.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19564.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18811.71,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Appendix Procedures With Cc","code_information":[{"code":"398","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":20780.67,"10th_percentile":20780.67,"90th_percentile":20780.67},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":62463.27,"10th_percentile":62463.27,"90th_percentile":62463.27},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":12113.33,"maximum":29677.66,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29677.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29677.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12113.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12597.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12113.33,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Appendix Procedures Without Cc/Mcc","code_information":[{"code":"399","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":13806.33,"10th_percentile":13806.33,"90th_percentile":13806.33},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9135.51,"10th_percentile":9135.51,"90th_percentile":9135.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":9309.48,"maximum":22808.23,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22808.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22808.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9309.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9681.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9309.48,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"No Longer Valid","code_information":[{"code":"400","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":77931.56,"10th_percentile":77931.56,"90th_percentile":77931.56},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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With Mcc","code_information":[{"code":"408","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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With Cc","code_information":[{"code":"415","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13686.3,"10th_percentile":13686.3,"90th_percentile":13686.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":15568.55,"maximum":38142.95,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":38142.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38142.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15568.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16191.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15568.55,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Cc","code_information":[{"code":"433","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":23766.83,"10th_percentile":23766.83,"90th_percentile":23766.83},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7.6,"10th_percentile":7.6,"90th_percentile":7.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":14780.49,"10th_percentile":4230.17,"90th_percentile":15582.42},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7.91,"10th_percentile":7.9,"90th_percentile":8555.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":8636.83,"maximum":21160.23,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21160.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21160.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8636.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8982.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8636.83,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"434","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4348.83,"10th_percentile":4348.83,"90th_percentile":4348.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":6024.51,"maximum":14760.05,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14760.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14760.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6024.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6265.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6024.51,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","code_information":[{"code":"435","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14223.4,"10th_percentile":14223.4,"90th_percentile":14223.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"1 through 10","median_amount":14058.48,"10th_percentile":14058.48,"90th_percentile":14058.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14517.44,"10th_percentile":14517.44,"90th_percentile":14517.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":14569.07,"maximum":35694.22,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35694.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35694.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14569.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15151.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14569.07,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Cc","code_information":[{"code":"436","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":9206.11,"maximum":22554.97,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22554.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22554.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9206.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9574.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9206.11,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","code_information":[{"code":"437","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":7094.67,"maximum":17381.94,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17381.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17381.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7094.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7378.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7094.67,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Disorders Of Pancreas Except Malignancy With Mcc","code_information":[{"code":"438","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"1 through 10","median_amount":12855.95,"10th_percentile":12855.95,"90th_percentile":12855.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":12999.55,"maximum":31848.90,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31848.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31848.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12999.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13519.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12999.55,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Disorders Of Pancreas Except Malignancy With Cc","code_information":[{"code":"439","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":17619.83,"10th_percentile":17619.83,"90th_percentile":17619.83},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"14","median_amount":6870.17,"10th_percentile":7.76,"90th_percentile":6880.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"1 through 10","median_amount":6201.12,"10th_percentile":6201.12,"90th_percentile":52920.62}]},{"setting":"inpatient","billing_class":"facility","minimum":7002.71,"maximum":17156.64,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17156.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17156.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7002.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7282.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7002.71,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","code_information":[{"code":"440","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":15849.09,"10th_percentile":15849.09,"90th_percentile":29168.25},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":17657.63,"10th_percentile":17657.63,"90th_percentile":17657.63},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7.68,"10th_percentile":7.68,"90th_percentile":11059.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13032.82,"10th_percentile":13032.82,"90th_percentile":13032.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":13308.9,"maximum":32606.80,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32606.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32606.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13308.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13841.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13308.9,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Disorders Of The Biliary Tract With Cc","code_information":[{"code":"445","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":4746.45,"10th_percentile":4746.45,"90th_percentile":4746.45},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":18952.54,"10th_percentile":18952.54,"90th_percentile":30109.47},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7483.91,"10th_percentile":7483.91,"90th_percentile":7483.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":8927.17,"maximum":21871.57,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21871.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21871.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8927.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9284.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8927.17,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Disorders Of The Biliary Tract Without Cc/Mcc","code_information":[{"code":"446","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":6897.06,"maximum":16897.80,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16897.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16897.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6897.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7172.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6897.06,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody","code_information":[{"code":"447","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":139881.58,"10th_percentile":139881.58,"90th_percentile":139881.58},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25601.26,"10th_percentile":25601.26,"90th_percentile":25601.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":27413.27,"maximum":67162.51,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":67162.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":67162.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27413.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28509.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27413.27,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Revision Of Hip Or Knee Replacement Without Cc/Mcc","code_information":[{"code":"468","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19160.61,"10th_percentile":19160.61,"90th_percentile":19160.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20335.55,"10th_percentile":20335.55,"90th_percentile":20335.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":23663.15,"maximum":57974.72,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":57974.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57974.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23663.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24609.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23663.15,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","code_information":[{"code":"470","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13349.92,"10th_percentile":13349.92,"90th_percentile":13349.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14685.76,"10th_percentile":14685.76,"90th_percentile":14685.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12014.9,"10th_percentile":2160.0,"90th_percentile":20520.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":22744.24,"maximum":55723.39,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":55723.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55723.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22744.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23654.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22744.24,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Hip And Femur Procedures Except Major Joint With Cc","code_information":[{"code":"481","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13666.92,"10th_percentile":7.82,"90th_percentile":15528.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":64859.94,"10th_percentile":64859.94,"90th_percentile":64859.94},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":13812.42,"10th_percentile":7.9,"90th_percentile":15436.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15460.67,"10th_percentile":15460.67,"90th_percentile":15460.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":16528.5,"maximum":40494.82,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40494.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40494.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16528.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17189.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16528.5,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","code_information":[{"code":"482","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11088.38,"10th_percentile":11088.38,"90th_percentile":11088.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"1 through 10","median_amount":57978.44,"10th_percentile":57978.44,"90th_percentile":57978.44}]},{"setting":"inpatient","billing_class":"facility","minimum":13005.63,"maximum":31863.79,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31863.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31863.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13005.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13525.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13005.63,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","code_information":[{"code":"483","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19681.76,"10th_percentile":16.26,"90th_percentile":19768.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":30820.54,"10th_percentile":30820.54,"90th_percentile":30820.54},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"1 through 10","median_amount":69026.0,"10th_percentile":69026.0,"90th_percentile":69026.0}]},{"setting":"inpatient","billing_class":"facility","minimum":15859.65,"maximum":38856.14,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":38856.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38856.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15859.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16494.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15859.65,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc","code_information":[{"code":"495","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":16413.73,"maximum":40213.64,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40213.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40213.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16413.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17070.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16413.73,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","code_information":[{"code":"512","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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Procedures With Mcc","code_information":[{"code":"515","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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Procedures With Cc","code_information":[{"code":"516","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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Procedures Without Cc/Mcc","code_information":[{"code":"517","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":12288.9,"maximum":30107.80,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30107.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30107.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12288.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12780.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12288.9,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","code_information":[{"code":"518","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":29014.71,"maximum":71086.04,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":71086.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":71086.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29014.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30175.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29014.71,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Cc","code_information":[{"code":"519","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":27742.32,"10th_percentile":27742.32,"90th_percentile":27742.32},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":15811.76,"maximum":38738.81,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":38738.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38738.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15811.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16444.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15811.76,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","code_information":[{"code":"520","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":27077.43,"10th_percentile":27077.43,"90th_percentile":27077.43},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9365.59,"10th_percentile":9365.59,"90th_percentile":9365.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"1 through 10","median_amount":11135.26,"10th_percentile":11135.26,"90th_percentile":11135.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":11963.6,"maximum":29310.82,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29310.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29310.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11963.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12442.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11963.6,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","code_information":[{"code":"521","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":22424.26,"maximum":54939.44,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":54939.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54939.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22424.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23321.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22424.26,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","code_information":[{"code":"522","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14136.8,"10th_percentile":14136.8,"90th_percentile":15770.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14858.93,"10th_percentile":7.9,"90th_percentile":15331.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transient ischemia","code_information":[{"code":"524","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other heart assist system implant","code_information":[{"code":"525","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":6747.33,"maximum":16530.96,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16530.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16530.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6747.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6747.33,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc","code_information":[{"code":"537","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":13348.42,"maximum":32703.63,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32703.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32703.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13348.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13882.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13348.42,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Medical Back Problems Without Mcc","code_information":[{"code":"552","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7392.49,"10th_percentile":7392.49,"90th_percentile":7392.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"1 through 10","median_amount":11403.17,"10th_percentile":11403.17,"90th_percentile":11403.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":11411.8,"maximum":27958.91,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27958.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27958.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11411.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11868.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11411.8,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Cellulitis Without Mcc","code_information":[{"code":"603","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":7861.73,"10th_percentile":7861.73,"90th_percentile":7861.73},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5561.51,"10th_percentile":5561.51,"90th_percentile":5561.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":7228.44,"maximum":17709.68,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17709.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17709.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7228.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7517.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7228.44,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","code_information":[{"code":"604","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10297.1,"10th_percentile":10297.1,"90th_percentile":10297.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":11797.9,"maximum":28904.86,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28904.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28904.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11797.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12269.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11797.9,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","code_information":[{"code":"605","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11670.28,"10th_percentile":11670.28,"90th_percentile":11670.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":11528.84,"maximum":28245.66,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28245.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28245.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11528.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11989.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11528.84,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Diabetes With Cc","code_information":[{"code":"638","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":16224.9,"10th_percentile":16224.9,"90th_percentile":16224.9},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":8417.46,"10th_percentile":8417.46,"90th_percentile":19696.84},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":860.96,"10th_percentile":860.96,"90th_percentile":860.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7526.26,"10th_percentile":7526.26,"90th_percentile":7526.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"1 through 10","median_amount":15474.07,"10th_percentile":15474.07,"90th_percentile":15474.07}]},{"setting":"inpatient","billing_class":"facility","minimum":7420.74,"maximum":18180.81,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18180.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18180.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7420.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7717.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7420.74,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Diabetes Without Cc/Mcc","code_information":[{"code":"639","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":14072.29,"10th_percentile":14072.29,"90th_percentile":14072.29},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":6383.19,"10th_percentile":6383.19,"90th_percentile":6383.19},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":29064.44,"10th_percentile":29064.44,"90th_percentile":29064.44},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":5330.58,"maximum":13059.92,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13059.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13059.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5330.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5543.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5330.58,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","code_information":[{"code":"640","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4334.33,"10th_percentile":4334.33,"90th_percentile":4334.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":12046.73,"10th_percentile":12046.73,"90th_percentile":12046.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10077.39,"10th_percentile":10077.39,"90th_percentile":10077.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":21086.91,"10th_percentile":21086.91,"90th_percentile":21086.91},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"16","median_amount":8373.48,"10th_percentile":7.68,"90th_percentile":10522.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":31738.95,"10th_percentile":31738.95,"90th_percentile":31738.95},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":10760.43,"maximum":26363.05,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26363.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26363.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10760.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11190.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10760.43,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","code_information":[{"code":"641","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":14123.01,"10th_percentile":14123.01,"90th_percentile":14123.01},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4156.08,"10th_percentile":4156.08,"90th_percentile":6130.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":9251.93,"10th_percentile":3851.11,"90th_percentile":21998.55},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24.4,"10th_percentile":8.13,"90th_percentile":1461.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":4334.93,"10th_percentile":4334.93,"90th_percentile":4334.93},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":1711.69,"10th_percentile":1711.69,"90th_percentile":1711.69},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24.18,"10th_percentile":8.06,"90th_percentile":5796.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":6523.87,"maximum":15983.48,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15983.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15983.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6523.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6784.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6523.87,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Inborn And Other Disorders Of Metabolism","code_information":[{"code":"642","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":7319.31,"10th_percentile":7319.31,"90th_percentile":7319.31},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7099.81,"10th_percentile":7099.81,"90th_percentile":7099.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":8399.69,"maximum":20579.24,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20579.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20579.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8399.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8735.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8399.69,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Endocrine Disorders Without Cc/Mcc","code_information":[{"code":"645","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":12403.67,"maximum":30388.99,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30388.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30388.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12403.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12899.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12403.67,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With Mcc","code_information":[{"code":"659","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":19921.39,"maximum":48807.41,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":48807.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48807.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19921.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20718.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19921.39,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With Cc","code_information":[{"code":"660","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":22578.45,"10th_percentile":22578.45,"90th_percentile":22578.45},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":15517.46,"10th_percentile":15517.46,"90th_percentile":15517.46},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9884.94,"10th_percentile":9884.94,"90th_percentile":9884.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":12405.19,"maximum":30392.72,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30392.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30392.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12405.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12901.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12405.19,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Transurethral Procedures Without Cc/Mcc","code_information":[{"code":"670","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":8037.14,"maximum":19690.99,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19690.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19690.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8037.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8358.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8037.14,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Urethral Procedures With Cc/Mcc","code_information":[{"code":"671","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":14252.13,"maximum":34917.72,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34917.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34917.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14252.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14822.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14252.13,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Urethral Procedures Without Cc/Mcc","code_information":[{"code":"672","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":32543.65,"maximum":79731.94,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":79731.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":79731.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32543.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33845.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32543.65,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Kidney And Urinary Tract Procedures With Cc","code_information":[{"code":"674","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11832.68,"10th_percentile":11832.68,"90th_percentile":11832.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6334.71,"10th_percentile":15.68,"90th_percentile":11013.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":11865.55,"maximum":29070.60,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29070.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29070.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11865.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12340.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11865.55,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Renal Failure With Cc","code_information":[{"code":"683","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7.6,"10th_percentile":7.6,"90th_percentile":6154.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":10075.45,"10th_percentile":10075.45,"90th_percentile":10075.45},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7.9,"10th_percentile":7.9,"90th_percentile":6876.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":7265.69,"maximum":17800.94,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17800.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17800.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7265.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7556.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7265.69,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Renal Failure Without Cc/Mcc","code_information":[{"code":"684","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":5171.73,"maximum":12670.74,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12670.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12670.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5171.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5378.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5171.73,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Admit For Renal Dialysis","code_information":[{"code":"685","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15.8,"10th_percentile":15.8,"90th_percentile":7576.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":6761.77,"maximum":16566.34,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16566.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16566.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6761.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7032.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6761.77,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Urinary Stones W Esw Lithotripsy W Cc/Mcc","code_information":[{"code":"691","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":11282.59,"maximum":27642.35,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27642.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27642.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11282.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11733.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11282.59,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Red Blood Cell Disorders Without Mcc","code_information":[{"code":"812","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2688.46,"10th_percentile":2688.46,"90th_percentile":5878.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32766.11,"10th_percentile":32766.11,"90th_percentile":32766.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":24327.7,"10th_percentile":24327.7,"90th_percentile":24327.7},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":12467.84,"10th_percentile":7.82,"90th_percentile":14672.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":12.62,"10th_percentile":12.62,"90th_percentile":45574.2},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"27","median_amount":2663.9,"10th_percentile":7.68,"90th_percentile":15298.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"1 through 10","median_amount":27228.8,"10th_percentile":27228.8,"90th_percentile":27228.8}]},{"setting":"inpatient","billing_class":"facility","minimum":15373.21,"maximum":37664.36,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37664.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37664.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15373.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15988.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15373.21,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","code_information":[{"code":"872","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":13394.28,"10th_percentile":24.15,"90th_percentile":24055.41},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7385.99,"10th_percentile":7385.99,"90th_percentile":7926.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"11","median_amount":10160.43,"10th_percentile":9.47,"90th_percentile":21730.47},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4671.41,"10th_percentile":7.9,"90th_percentile":6923.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":32632.22,"10th_percentile":32632.22,"90th_percentile":32632.22},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":7907.17,"maximum":19372.57,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19372.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19372.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7907.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8223.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7907.17,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Depressive Neuroses","code_information":[{"code":"881","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":17701.45,"10th_percentile":17701.45,"90th_percentile":17701.45},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":18576.46,"10th_percentile":18576.46,"90th_percentile":18576.46},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":8364.84,"10th_percentile":8364.84,"90th_percentile":8364.84},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":717.14,"10th_percentile":717.14,"90th_percentile":717.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"34","median_amount":18702.18,"10th_percentile":1438.5,"90th_percentile":45018.76},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":11102.76,"10th_percentile":8772.92,"90th_percentile":11138.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":14963.34,"10th_percentile":12459.33,"90th_percentile":15807.21},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":4615.37,"10th_percentile":4615.37,"90th_percentile":4615.37},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9360.47,"10th_percentile":9360.47,"90th_percentile":10721.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"1 through 10","median_amount":10852.11,"10th_percentile":10852.11,"90th_percentile":21076.63}]},{"setting":"inpatient","billing_class":"facility","minimum":11225.58,"maximum":27502.67,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27502.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27502.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11225.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11674.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11225.58,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Behavioral And Developmental Disorders","code_information":[{"code":"886","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":10107.65,"10th_percentile":10107.65,"90th_percentile":10107.65},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":16382.57,"maximum":40137.30,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40137.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40137.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16382.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17037.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16382.57,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Other Mental Disorder Diagnoses","code_information":[{"code":"887","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":8748.56,"maximum":21433.97,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21433.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21433.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8748.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9098.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8748.56,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Alcohol, Drug Abuse Or Dependence, Left Ama","code_information":[{"code":"894","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":7501.14,"10th_percentile":25.24,"90th_percentile":26102.53},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7.9,"10th_percentile":7.9,"90th_percentile":3136.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":5297.9,"maximum":12979.86,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12979.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12979.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5297.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5509.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5297.9,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy","code_information":[{"code":"895","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":11368.47,"maximum":27852.75,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27852.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27852.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11368.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11823.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11368.47,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","code_information":[{"code":"896","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7283.9,"10th_percentile":7283.9,"90th_percentile":7283.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":13872.86,"maximum":33988.51,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33988.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33988.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13872.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14427.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13872.86,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","code_information":[{"code":"897","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":36935.08,"10th_percentile":36935.08,"90th_percentile":36935.08},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6777.46,"10th_percentile":6777.46,"90th_percentile":6777.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":4438.04,"10th_percentile":4438.04,"90th_percentile":4438.04},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":13374.13,"10th_percentile":13374.13,"90th_percentile":13374.13},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14509.76,"10th_percentile":14509.76,"90th_percentile":14509.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":6693.36,"maximum":16398.73,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16398.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16398.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6693.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6961.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6693.36,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Aftercare With Cc/Mcc","code_information":[{"code":"949","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2908.29,"10th_percentile":7.9,"90th_percentile":2980.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"981","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31823.91,"10th_percentile":31823.91,"90th_percentile":31823.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":53259.43,"10th_percentile":53259.43,"90th_percentile":53259.43},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36301.75,"10th_percentile":36301.75,"90th_percentile":36301.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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Procedures Unrelated To Principal Diagnosis With Cc","code_information":[{"code":"982","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":34659.74,"10th_percentile":34659.74,"90th_percentile":34659.74},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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Procedure Unrelated To Principal Diagnosis W Mcc","code_information":[{"code":"984","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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Procedure Unrelated To Principal Diagnosis W Cc","code_information":[{"code":"985","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. 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Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc","code_information":[{"code":"986","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"987","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25820.13,"10th_percentile":25820.13,"90th_percentile":25820.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"1 through 10","median_amount":47939.92,"10th_percentile":47939.92,"90th_percentile":47939.92}]},{"setting":"inpatient","billing_class":"facility","minimum":26666.89,"maximum":65333.88,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":65333.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":65333.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26666.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27733.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26666.89,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","code_information":[{"code":"988","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":26414.28,"10th_percentile":26414.28,"90th_percentile":26414.28},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13179.47,"10th_percentile":13179.47,"90th_percentile":13179.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"1 through 10","median_amount":15.96,"10th_percentile":7.98,"90th_percentile":13324.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":13101.4,"maximum":32098.43,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32098.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32098.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13101.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13625.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13101.4,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"989","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":9723.71,"maximum":23823.09,"payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23823.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23823.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9723.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10112.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9723.71,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Principal Diagnosis Invalid As Discharge Diagnosis","code_information":[{"code":"998","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ungroupable","code_information":[{"code":"999","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dactinomycin injection","code_information":[{"code":"0752","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":17803.97,"10th_percentile":17803.97,"90th_percentile":17803.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inj, bupivacaine liposome","code_information":[{"code":"0763","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":18572.3,"10th_percentile":18572.3,"90th_percentile":28519.27},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":16316.18,"10th_percentile":10393.02,"90th_percentile":25454.21},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7413.2,"10th_percentile":3620.5,"90th_percentile":13587.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"16","median_amount":15536.26,"10th_percentile":4674.95,"90th_percentile":33037.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":7771.07,"10th_percentile":6420.2,"90th_percentile":14269.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":43079.03,"10th_percentile":43079.03,"90th_percentile":43079.03},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":12154.39,"10th_percentile":12154.39,"90th_percentile":12154.39},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"1 through 10","median_amount":25265.66,"10th_percentile":25265.66,"90th_percentile":25265.66}]}]},{"description":"Ketorolac tromethamine inj","code_information":[{"code":"0764","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8228.06,"10th_percentile":8228.06,"90th_percentile":21426.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":8919.95,"10th_percentile":8580.38,"90th_percentile":13628.75},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":14123.1,"10th_percentile":14123.1,"90th_percentile":14123.1},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":12417.92,"10th_percentile":7578.67,"90th_percentile":18395.44},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":4531.68,"10th_percentile":4531.68,"90th_percentile":4531.68},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4949.75,"10th_percentile":4949.75,"90th_percentile":4949.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"31","median_amount":8321.35,"10th_percentile":4439.19,"90th_percentile":21926.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2866.42,"10th_percentile":23.04,"90th_percentile":7052.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":5450.9,"10th_percentile":5450.9,"90th_percentile":21895.1},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":8916.73,"10th_percentile":3700.7,"90th_percentile":12947.4},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":2348.16,"10th_percentile":2348.16,"90th_percentile":5590.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":422.71,"10th_percentile":421.9,"90th_percentile":1100.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inj, methylpred sod succ 5mg","code_information":[{"code":"0801","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":404.22,"10th_percentile":404.22,"90th_percentile":404.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"65","median_amount":129.01,"10th_percentile":12.62,"90th_percentile":543.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1248","median_amount":140.67,"10th_percentile":52.54,"90th_percentile":236.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"37","median_amount":270.96,"10th_percentile":74.44,"90th_percentile":352.66},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"38","median_amount":121.73,"10th_percentile":61.73,"90th_percentile":234.2},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"150","median_amount":138.02,"10th_percentile":138.02,"90th_percentile":155.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"646","median_amount":143.38,"10th_percentile":74.4,"90th_percentile":241.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"42","median_amount":125.79,"10th_percentile":100.63,"90th_percentile":314.34}]}]},{"description":"Level 1 Type A ED Visits","code_information":[{"code":"5021","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":87.44,"10th_percentile":87.44,"90th_percentile":87.44},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":66.23,"10th_percentile":66.23,"90th_percentile":66.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":232.74,"10th_percentile":87.75,"90th_percentile":658.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":50.35,"10th_percentile":50.35,"90th_percentile":175.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":208.17,"10th_percentile":208.17,"90th_percentile":208.17},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":578.46,"10th_percentile":300.0,"90th_percentile":974.02},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"23","median_amount":731.52,"10th_percentile":510.0,"90th_percentile":1446.59},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":392.53,"10th_percentile":188.55,"90th_percentile":1821.77},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":173.02,"10th_percentile":7.6,"90th_percentile":385.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"127","median_amount":569.57,"10th_percentile":13.01,"90th_percentile":1159.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"47","median_amount":179.74,"10th_percentile":7.91,"90th_percentile":443.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":835.1,"10th_percentile":577.67,"90th_percentile":2023.3},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":881.52,"10th_percentile":504.68,"90th_percentile":2051.78},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"23","median_amount":438.61,"10th_percentile":168.79,"90th_percentile":1205.98}]}]},{"description":"Level 4 Type A ED Visits","code_information":[{"code":"5024","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1513.0,"10th_percentile":1513.0,"90th_percentile":1513.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":1478.33,"10th_percentile":12.62,"90th_percentile":2049.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"40","median_amount":1176.93,"10th_percentile":14.07,"90th_percentile":2872.9},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"24","median_amount":1760.45,"10th_percentile":1160.77,"90th_percentile":2327.55},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"72","median_amount":1315.52,"10th_percentile":21.73,"90th_percentile":2949.85},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":1479.59,"10th_percentile":100.02,"90th_percentile":2550.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"76","median_amount":421.74,"10th_percentile":7.6,"90th_percentile":839.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"315","median_amount":1445.7,"10th_percentile":10.73,"90th_percentile":4323.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":3241.45,"10th_percentile":3241.45,"90th_percentile":3241.45},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"238","median_amount":342.84,"10th_percentile":7.68,"90th_percentile":888.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"16","median_amount":1683.57,"10th_percentile":10.61,"90th_percentile":4720.98},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"35","median_amount":2113.7,"10th_percentile":13.68,"90th_percentile":4976.35},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"36","median_amount":1520.24,"10th_percentile":32.0,"90th_percentile":3907.21}]}]},{"description":"Level 5 Type A ED Visits","code_information":[{"code":"5025","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2379.81,"10th_percentile":2057.45,"90th_percentile":3042.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"15","median_amount":3648.71,"10th_percentile":14.07,"90th_percentile":11312.11},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":3807.45,"10th_percentile":3807.45,"90th_percentile":4600.94},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"32","median_amount":3878.31,"10th_percentile":628.28,"90th_percentile":10859.31},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":6104.23,"10th_percentile":6104.23,"90th_percentile":6104.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"71","median_amount":637.51,"10th_percentile":7.6,"90th_percentile":2661.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"230","median_amount":3304.32,"10th_percentile":10.73,"90th_percentile":10609.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"208","median_amount":558.89,"10th_percentile":7.68,"90th_percentile":2767.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"14","median_amount":5332.3,"10th_percentile":14.15,"90th_percentile":24984.01},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"19","median_amount":7494.66,"10th_percentile":13.68,"90th_percentile":16487.56},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"156","median_amount":802.24,"10th_percentile":7.76,"90th_percentile":1781.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"113","median_amount":855.64,"10th_percentile":7.84,"90th_percentile":2837.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"28","median_amount":2258.89,"10th_percentile":16.0,"90th_percentile":7263.64}]}]},{"description":"Critical Care","code_information":[{"code":"5041","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":29385.59,"10th_percentile":29385.59,"90th_percentile":29385.59},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2759.48,"10th_percentile":2759.48,"90th_percentile":2759.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":10403.53,"10th_percentile":25.24,"90th_percentile":18597.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1372.69,"10th_percentile":7.68,"90th_percentile":9780.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":6918.39,"10th_percentile":6918.39,"90th_percentile":10984.88},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":23.52,"10th_percentile":23.52,"90th_percentile":23.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"1 through 10","median_amount":25262.68,"10th_percentile":25262.68,"90th_percentile":25262.68}]}]},{"description":"Level 1 Skin Procedures","code_information":[{"code":"5051","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":597.58,"10th_percentile":597.58,"90th_percentile":597.58},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":1252.6,"10th_percentile":1252.6,"90th_percentile":1252.6},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":166.43,"10th_percentile":166.43,"90th_percentile":166.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"20","median_amount":476.54,"10th_percentile":251.14,"90th_percentile":952.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"16","median_amount":172.79,"10th_percentile":158.09,"90th_percentile":217.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":754.89,"10th_percentile":754.89,"90th_percentile":754.89},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":879.74,"10th_percentile":879.74,"90th_percentile":879.74},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":176.97,"10th_percentile":53.54,"90th_percentile":305.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Skin Procedures","code_information":[{"code":"5052","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":1209.63,"10th_percentile":1209.63,"90th_percentile":1209.63},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":187.1,"10th_percentile":56.74,"90th_percentile":554.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"15","median_amount":572.99,"10th_percentile":397.98,"90th_percentile":818.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"17","median_amount":392.02,"10th_percentile":382.22,"90th_percentile":517.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":928.52,"10th_percentile":627.56,"90th_percentile":928.52},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":572.98,"10th_percentile":572.98,"90th_percentile":572.98},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":168.54,"10th_percentile":8.4,"90th_percentile":446.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"1 through 10","median_amount":845.84,"10th_percentile":845.84,"90th_percentile":845.84}]}]},{"description":"Level 3 Skin Procedures","code_information":[{"code":"5053","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":2481.4,"10th_percentile":2481.4,"90th_percentile":2481.4},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":621.21,"10th_percentile":621.21,"90th_percentile":673.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"1 through 10","median_amount":5002.6,"10th_percentile":5002.6,"90th_percentile":5002.6}]}]},{"description":"Level 1 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5071","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":1632.58,"10th_percentile":1632.58,"90th_percentile":1632.58},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":11180.92,"10th_percentile":11180.92,"90th_percentile":11180.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4018.96,"10th_percentile":4018.96,"90th_percentile":4018.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"12","median_amount":2126.99,"10th_percentile":1669.71,"90th_percentile":22216.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":511.7,"10th_percentile":13.41,"90th_percentile":7256.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":23170.23,"10th_percentile":23170.23,"90th_percentile":24227.86},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"1 through 10","median_amount":1392.96,"10th_percentile":1392.96,"90th_percentile":1392.96}]}]},{"description":"Level 2 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5072","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3697.91,"10th_percentile":3697.91,"90th_percentile":3697.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":3585.91,"10th_percentile":3501.68,"90th_percentile":4474.0},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"14","median_amount":2845.59,"10th_percentile":1177.16,"90th_percentile":6037.92},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":13373.17,"10th_percentile":13373.17,"90th_percentile":13373.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"14","median_amount":1396.83,"10th_percentile":1313.47,"90th_percentile":3934.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"48","median_amount":4014.93,"10th_percentile":1829.99,"90th_percentile":7689.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"28","median_amount":1425.6,"10th_percentile":685.7,"90th_percentile":4593.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":8540.87,"10th_percentile":4674.95,"90th_percentile":26018.34},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":8963.03,"10th_percentile":8963.03,"90th_percentile":8963.03},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"1 through 10","median_amount":5655.21,"10th_percentile":3309.95,"90th_percentile":8216.07}]}]},{"description":"Level 3 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5073","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":5378.19,"10th_percentile":5378.19,"90th_percentile":5378.19},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2616.85,"10th_percentile":2616.85,"90th_percentile":2616.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":4056.76,"10th_percentile":3904.95,"90th_percentile":7645.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2702.71,"10th_percentile":2702.71,"90th_percentile":3124.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Strapping and Cast Application","code_information":[{"code":"5101","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"54","median_amount":204.46,"10th_percentile":118.33,"90th_percentile":259.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":289.11,"10th_percentile":289.11,"90th_percentile":289.11},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":158.29,"10th_percentile":153.32,"90th_percentile":263.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"1 through 10","median_amount":389.67,"10th_percentile":389.67,"90th_percentile":389.67}]}]},{"description":"Level 1 Musculoskeletal Procedures","code_information":[{"code":"5111","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":3203.13,"10th_percentile":3203.13,"90th_percentile":3203.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Musculoskeletal Procedures","code_information":[{"code":"5112","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":3910.87,"10th_percentile":798.89,"90th_percentile":4533.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1624.45,"10th_percentile":1624.45,"90th_percentile":15483.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":3324.96,"10th_percentile":3324.96,"90th_percentile":3324.96},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1658.05,"10th_percentile":1658.05,"90th_percentile":1658.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"1 through 10","median_amount":3286.23,"10th_percentile":3286.23,"90th_percentile":3286.23}]}]},{"description":"Level 1 Airway Endoscopy","code_information":[{"code":"5151","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":1834.28,"10th_percentile":1834.28,"90th_percentile":2689.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":331.88,"10th_percentile":331.88,"90th_percentile":470.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":2925.23,"10th_percentile":2925.23,"90th_percentile":2925.23},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":809.13,"10th_percentile":687.86,"90th_percentile":885.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Vascular Procedures","code_information":[{"code":"5182","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":692.3,"10th_percentile":692.3,"90th_percentile":692.3},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":2159.07,"10th_percentile":2159.07,"90th_percentile":2159.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1630.46,"10th_percentile":1630.46,"90th_percentile":1630.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":2036.66,"10th_percentile":1900.88,"90th_percentile":2337.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":1352.67,"10th_percentile":1274.27,"90th_percentile":1702.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"1 through 10","median_amount":1663.73,"10th_percentile":1663.73,"90th_percentile":1663.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1734.94,"10th_percentile":1734.94,"90th_percentile":1734.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"1 through 10","median_amount":7879.85,"10th_percentile":7879.85,"90th_percentile":7879.85}]}]},{"description":"Level 3 Vascular Procedures","code_information":[{"code":"5183","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":9438.7,"10th_percentile":9438.7,"90th_percentile":9438.7},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":10132.31,"10th_percentile":10132.31,"90th_percentile":11814.56},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3009.55,"10th_percentile":2911.55,"90th_percentile":3156.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"12","median_amount":11238.79,"10th_percentile":10015.59,"90th_percentile":11892.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3014.29,"10th_percentile":2352.79,"90th_percentile":3449.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":10533.61,"10th_percentile":10533.61,"90th_percentile":10533.61},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":2467.49,"10th_percentile":2467.49,"90th_percentile":2467.49},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"1 through 10","median_amount":13543.01,"10th_percentile":13543.01,"90th_percentile":19294.92}]}]},{"description":"Level 4 Vascular Procedures","code_information":[{"code":"5184","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9658.14,"10th_percentile":9658.14,"90th_percentile":9658.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Endovascular Procedures","code_information":[{"code":"5191","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":15255.05,"10th_percentile":15255.05,"90th_percentile":15255.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":26169.24,"10th_percentile":26169.24,"90th_percentile":26169.24},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":7762.35,"10th_percentile":7762.35,"90th_percentile":20483.72},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5881.93,"10th_percentile":3326.88,"90th_percentile":8514.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"13","median_amount":22395.25,"10th_percentile":18110.85,"90th_percentile":26584.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"36","median_amount":3510.92,"10th_percentile":3089.52,"90th_percentile":6718.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":20692.04,"10th_percentile":20692.04,"90th_percentile":20692.04},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":16365.68,"10th_percentile":16365.68,"90th_percentile":16365.68},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":5802.09,"10th_percentile":3142.35,"90th_percentile":6708.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"1 through 10","median_amount":17947.44,"10th_percentile":17947.44,"90th_percentile":17947.44}]}]},{"description":"Level 2 Endovascular Procedures","code_information":[{"code":"5192","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":24167.43,"10th_percentile":24167.43,"90th_percentile":24167.43},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11661.74,"10th_percentile":11661.74,"90th_percentile":11661.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":44107.69,"10th_percentile":44107.69,"90th_percentile":44107.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12344.79,"10th_percentile":12344.79,"90th_percentile":12344.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7744.44,"10th_percentile":7744.44,"90th_percentile":7744.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Endovascular Procedures","code_information":[{"code":"5193","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":75050.15,"10th_percentile":75050.15,"90th_percentile":77299.91},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18716.14,"10th_percentile":17390.46,"90th_percentile":19461.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":75025.1,"10th_percentile":64480.5,"90th_percentile":95409.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":15143.99,"10th_percentile":13072.05,"90th_percentile":21724.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":49108.69,"10th_percentile":49108.69,"90th_percentile":49108.69},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"1 through 10","median_amount":16868.43,"10th_percentile":16868.43,"90th_percentile":16868.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"1 through 10","median_amount":19714.76,"10th_percentile":19714.76,"90th_percentile":19714.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"1 through 10","median_amount":57101.86,"10th_percentile":57101.86,"90th_percentile":57101.86}]}]},{"description":"Level 4 Endovascular Procedures","code_information":[{"code":"5194","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":27602.77,"10th_percentile":27602.77,"90th_percentile":27602.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":19257.9,"10th_percentile":19257.9,"90th_percentile":26559.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Electrophysiologic Procedures","code_information":[{"code":"5212","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7915.32,"10th_percentile":7915.32,"90th_percentile":7915.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":53619.46,"10th_percentile":51266.59,"90th_percentile":60362.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8006.09,"10th_percentile":8006.09,"90th_percentile":8006.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Electrophysiologic Procedures","code_information":[{"code":"5213","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":124052.79,"10th_percentile":124052.79,"90th_percentile":124052.79},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":77414.17,"10th_percentile":77414.17,"90th_percentile":77414.17},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":28261.47,"10th_percentile":26000.22,"90th_percentile":29353.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"14","median_amount":93685.98,"10th_percentile":74680.58,"90th_percentile":109656.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":26786.14,"10th_percentile":26685.45,"90th_percentile":27664.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":47550.84,"10th_percentile":47550.84,"90th_percentile":74392.52},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":49112.6,"10th_percentile":49112.6,"90th_percentile":49649.17},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":29737.31,"10th_percentile":27293.53,"90th_percentile":30603.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"1 through 10","median_amount":132985.89,"10th_percentile":132985.89,"90th_percentile":132985.89}]}]},{"description":"Level 2 Pacemaker and Similar Procedures","code_information":[{"code":"5222","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8588.3,"10th_percentile":8588.3,"90th_percentile":8588.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8940.65,"10th_percentile":8940.65,"90th_percentile":8940.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8771.38,"10th_percentile":8771.38,"90th_percentile":8771.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Pacemaker and Similar Procedures","code_information":[{"code":"5223","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10935.2,"10th_percentile":10935.2,"90th_percentile":12583.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":45921.32,"10th_percentile":45921.32,"90th_percentile":45921.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11423.57,"10th_percentile":11330.47,"90th_percentile":13033.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"1 through 10","median_amount":11624.1,"10th_percentile":11568.9,"90th_percentile":26544.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11643.26,"10th_percentile":11643.26,"90th_percentile":13551.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Pacemaker and Similar Procedures","code_information":[{"code":"5224","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":20724.28,"10th_percentile":20724.28,"90th_percentile":20724.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Blood Product Exchange and Related Services","code_information":[{"code":"5241","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":2097.74,"10th_percentile":2097.74,"90th_percentile":5380.06},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":649.88,"10th_percentile":649.88,"90th_percentile":649.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":2967.17,"10th_percentile":1970.33,"90th_percentile":12699.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":942.55,"10th_percentile":663.33,"90th_percentile":1282.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":4359.35,"10th_percentile":4359.35,"90th_percentile":4359.35},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1055.58,"10th_percentile":1055.58,"90th_percentile":1055.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"1 through 10","median_amount":2111.1,"10th_percentile":1684.9,"90th_percentile":5122.67}]}]},{"description":"Level 2 Blood Product Exchange and Related Services","code_information":[{"code":"5242","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2277.09,"10th_percentile":2277.09,"90th_percentile":2399.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Upper GI Procedures","code_information":[{"code":"5301","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3821.28,"10th_percentile":3821.28,"90th_percentile":3821.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":2811.57,"10th_percentile":1883.82,"90th_percentile":10523.71},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":1412.46,"10th_percentile":804.76,"90th_percentile":3578.41},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":2297.05,"10th_percentile":2297.05,"90th_percentile":2297.05},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":935.05,"10th_percentile":886.05,"90th_percentile":1430.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"52","median_amount":2899.88,"10th_percentile":1557.9,"90th_percentile":5111.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"24","median_amount":680.41,"10th_percentile":602.01,"90th_percentile":1148.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":3770.3,"10th_percentile":1888.7,"90th_percentile":4059.26},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"18","median_amount":2953.35,"10th_percentile":2953.35,"90th_percentile":4467.63},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"13","median_amount":3051.8,"10th_percentile":2789.07,"90th_percentile":3051.8}]}]},{"description":"Level 2 Upper GI Procedures","code_information":[{"code":"5302","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":9694.36,"10th_percentile":9694.36,"90th_percentile":9694.36},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":5914.99,"10th_percentile":5914.99,"90th_percentile":5914.99},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":4312.62,"10th_percentile":4312.62,"90th_percentile":4312.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1942.05,"10th_percentile":1942.05,"90th_percentile":2849.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"14","median_amount":7005.83,"10th_percentile":3877.2,"90th_percentile":8681.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1727.69,"10th_percentile":1649.29,"90th_percentile":3065.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":3461.96,"10th_percentile":3461.96,"90th_percentile":10485.24},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":6613.71,"10th_percentile":6613.71,"90th_percentile":6613.71},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2090.91,"10th_percentile":1723.41,"90th_percentile":2118.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"1 through 10","median_amount":5493.6,"10th_percentile":5493.6,"90th_percentile":5493.6}]}]},{"description":"Level 1 Lower GI Procedures","code_information":[{"code":"5311","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2734.03,"10th_percentile":2734.03,"90th_percentile":2734.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":2166.08,"10th_percentile":1963.69,"90th_percentile":2734.03},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"15","median_amount":1721.83,"10th_percentile":1684.73,"90th_percentile":1849.23},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":1684.73,"10th_percentile":1684.73,"90th_percentile":1684.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":956.91,"10th_percentile":956.91,"90th_percentile":956.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"109","median_amount":2166.08,"10th_percentile":2101.27,"90th_percentile":2407.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"19","median_amount":995.19,"10th_percentile":995.19,"90th_percentile":995.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"14","median_amount":2214.21,"10th_percentile":2214.21,"90th_percentile":2430.41},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"17","median_amount":2166.08,"10th_percentile":2166.08,"90th_percentile":2419.88},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"1 through 10","median_amount":2238.28,"10th_percentile":2238.28,"90th_percentile":2567.27}]}]},{"description":"Level 2 Lower GI Procedures","code_information":[{"code":"5312","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3535.81,"10th_percentile":3535.8,"90th_percentile":5303.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"34","median_amount":3535.8,"10th_percentile":2850.57,"90th_percentile":6748.21},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"44","median_amount":2719.68,"10th_percentile":2528.93,"90th_percentile":5120.26},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":4548.01,"10th_percentile":4548.01,"90th_percentile":5630.11},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"26","median_amount":1237.53,"10th_percentile":1188.53,"90th_percentile":2299.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"209","median_amount":3505.28,"10th_percentile":3156.23,"90th_percentile":6993.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":3328.66,"10th_percentile":3328.66,"90th_percentile":3328.66},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"63","median_amount":1287.03,"10th_percentile":1287.03,"90th_percentile":1930.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"15","median_amount":3583.17,"10th_percentile":3073.03,"90th_percentile":7524.68},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"33","median_amount":3651.09,"10th_percentile":3328.66,"90th_percentile":6121.48},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"64","median_amount":1262.79,"10th_percentile":1262.79,"90th_percentile":1894.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"34","median_amount":1311.79,"10th_percentile":1311.79,"90th_percentile":1967.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"22","median_amount":4105.95,"10th_percentile":3359.86,"90th_percentile":10265.94}]}]},{"description":"Level 3 Lower GI Procedures","code_information":[{"code":"5313","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":4807.96,"10th_percentile":4807.96,"90th_percentile":4807.96},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":9187.88,"10th_percentile":9187.88,"90th_percentile":9187.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Laparoscopy and Related Services","code_information":[{"code":"5362","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10943.11,"10th_percentile":10943.11,"90th_percentile":10943.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":29368.22,"10th_percentile":29368.22,"90th_percentile":29368.22},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Urology and Related Services","code_information":[{"code":"5371","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":135.26,"10th_percentile":100.43,"90th_percentile":235.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":251.31,"10th_percentile":251.31,"90th_percentile":251.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Urology and Related Services","code_information":[{"code":"5372","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":886.34,"10th_percentile":886.34,"90th_percentile":1679.75},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":906.83,"10th_percentile":170.8,"90th_percentile":1561.87},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"22","median_amount":313.46,"10th_percentile":308.56,"90th_percentile":492.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"32","median_amount":1453.52,"10th_percentile":1135.55,"90th_percentile":1739.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"40","median_amount":307.18,"10th_percentile":238.58,"90th_percentile":582.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":1113.64,"10th_percentile":1113.64,"90th_percentile":1113.64},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":1519.43,"10th_percentile":1519.43,"90th_percentile":1819.81},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"1 through 10","median_amount":536.14,"10th_percentile":536.14,"90th_percentile":536.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"47","median_amount":714.86,"10th_percentile":714.86,"90th_percentile":714.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"41","median_amount":355.5,"10th_percentile":306.5,"90th_percentile":742.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"1 through 10","median_amount":1481.14,"10th_percentile":1010.89,"90th_percentile":2657.94}]}]},{"description":"Level 3 Urology and Related Services","code_information":[{"code":"5373","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4599.8,"10th_percentile":4599.8,"90th_percentile":4599.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":5734.15,"10th_percentile":5734.15,"90th_percentile":5734.15},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"11","median_amount":2825.88,"10th_percentile":999.9,"90th_percentile":5781.96},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":1078.05,"10th_percentile":1078.05,"90th_percentile":1078.05},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1762.97,"10th_percentile":1762.97,"90th_percentile":2157.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"26","median_amount":2811.15,"10th_percentile":1620.63,"90th_percentile":5126.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"34","median_amount":1814.68,"10th_percentile":1153.18,"90th_percentile":2244.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"1 through 10","median_amount":4752.27,"10th_percentile":2904.86,"90th_percentile":17492.39}]}]},{"description":"Dialysis","code_information":[{"code":"5401","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":670.69,"10th_percentile":670.69,"90th_percentile":670.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":774.32,"10th_percentile":591.85,"90th_percentile":959.57},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":136.99,"10th_percentile":136.99,"90th_percentile":136.99},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"1 through 10","median_amount":641.01,"10th_percentile":641.01,"90th_percentile":641.01}]}]},{"description":"Level 2 Gynecologic Procedures","code_information":[{"code":"5412","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":235.01,"10th_percentile":235.01,"90th_percentile":235.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":462.89,"10th_percentile":391.28,"90th_percentile":491.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":982.0,"10th_percentile":982.0,"90th_percentile":982.0},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":59.8,"10th_percentile":59.8,"90th_percentile":59.8},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Nerve Injections","code_information":[{"code":"5442","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":1670.75,"10th_percentile":1670.75,"90th_percentile":1670.75},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":1320.93,"10th_percentile":1320.93,"90th_percentile":1320.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":763.53,"10th_percentile":763.53,"90th_percentile":763.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"34","median_amount":215.29,"10th_percentile":73.21,"90th_percentile":8074.28}]}]},{"description":"Level 2 Imaging without Contrast","code_information":[{"code":"5522","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":318.89,"10th_percentile":69.39,"90th_percentile":634.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"46","median_amount":424.98,"10th_percentile":217.31,"90th_percentile":1011.61},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"23","median_amount":501.71,"10th_percentile":246.92,"90th_percentile":1147.08},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"116","median_amount":450.45,"10th_percentile":174.65,"90th_percentile":811.13},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"16","median_amount":450.45,"10th_percentile":251.13,"90th_percentile":777.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"137","median_amount":111.61,"10th_percentile":62.61,"90th_percentile":222.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"405","median_amount":488.78,"10th_percentile":188.59,"90th_percentile":1007.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"253","median_amount":116.55,"10th_percentile":116.08,"90th_percentile":231.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"33","median_amount":326.83,"10th_percentile":137.72,"90th_percentile":1052.6},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"33","median_amount":494.78,"10th_percentile":224.55,"90th_percentile":1122.75},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"22","median_amount":724.86,"10th_percentile":397.43,"90th_percentile":1635.76},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"16","median_amount":1793.08,"10th_percentile":651.1,"90th_percentile":5224.23},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"43","median_amount":1026.9,"10th_percentile":362.5,"90th_percentile":1859.38},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":1014.15,"10th_percentile":1014.15,"90th_percentile":1583.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"49","median_amount":155.7,"10th_percentile":8.7,"90th_percentile":330.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"18","median_amount":1111.69,"10th_percentile":743.18,"90th_percentile":2771.96},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":2239.11,"10th_percentile":1259.91,"90th_percentile":3062.76},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"16","median_amount":920.06,"10th_percentile":309.59,"90th_percentile":4944.99},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"37","median_amount":526.49,"10th_percentile":526.49,"90th_percentile":661.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"18","median_amount":2465.75,"10th_percentile":632.4,"90th_percentile":5219.16}]}]},{"description":"Level 2 Imaging with Contrast","code_information":[{"code":"5572","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1026.26,"10th_percentile":194.06,"90th_percentile":2063.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"28","median_amount":1428.74,"10th_percentile":278.1,"90th_percentile":3262.28},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":5019.67,"10th_percentile":2720.21,"90th_percentile":6728.6},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"67","median_amount":1467.29,"10th_percentile":691.36,"90th_percentile":6866.8},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":2318.75,"10th_percentile":1047.0,"90th_percentile":2666.79},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"64","median_amount":129.84,"10th_percentile":80.84,"90th_percentile":578.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"218","median_amount":2571.65,"10th_percentile":1158.31,"90th_percentile":6309.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"149","median_amount":46.83,"10th_percentile":46.83,"90th_percentile":933.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"27","median_amount":2395.91,"10th_percentile":1355.29,"90th_percentile":6796.06},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"29","median_amount":2791.58,"10th_percentile":883.35,"90th_percentile":6756.32},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":1889.22,"10th_percentile":1073.12,"90th_percentile":2939.42},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":661.73,"10th_percentile":647.09,"90th_percentile":2460.14},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":957.14,"10th_percentile":957.14,"90th_percentile":957.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"23","median_amount":1981.61,"10th_percentile":1031.97,"90th_percentile":2475.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"1 through 10","median_amount":646.0,"10th_percentile":646.0,"90th_percentile":874.94}]}]},{"description":"Level 1 Nuclear Medicine and Related Services","code_information":[{"code":"5591","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":903.76,"10th_percentile":903.76,"90th_percentile":903.76},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":1207.68,"10th_percentile":1207.68,"90th_percentile":1207.68},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"16","median_amount":2179.27,"10th_percentile":1851.15,"90th_percentile":2807.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":438.62,"10th_percentile":33.88,"90th_percentile":828.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"18","median_amount":2196.81,"10th_percentile":1490.4,"90th_percentile":4211.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"25","median_amount":4317.08,"10th_percentile":2725.66,"90th_percentile":5247.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"57","median_amount":1033.02,"10th_percentile":637.1,"90th_percentile":1425.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":4810.43,"10th_percentile":4810.43,"90th_percentile":4810.43},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":3138.99,"10th_percentile":3082.9,"90th_percentile":5707.86},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"1 through 10","median_amount":4761.46,"10th_percentile":2371.36,"90th_percentile":6483.62}]}]},{"description":"Level 4 Nuclear Medicine and Related Services","code_information":[{"code":"5594","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4374.02,"10th_percentile":4374.02,"90th_percentile":4374.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":10468.35,"10th_percentile":8723.63,"90th_percentile":10570.56},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":7331.55,"10th_percentile":6891.27,"90th_percentile":15678.88},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":6473.54,"10th_percentile":6473.54,"90th_percentile":6473.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":1285.91,"10th_percentile":1236.91,"90th_percentile":1530.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"38","median_amount":10080.72,"10th_percentile":7174.22,"90th_percentile":19406.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"55","median_amount":1249.15,"10th_percentile":1249.15,"90th_percentile":5645.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":8025.74,"10th_percentile":3422.95,"90th_percentile":10700.98},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":11409.23,"10th_percentile":6003.36,"90th_percentile":11767.95},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"1 through 10","median_amount":10817.3,"10th_percentile":8653.84,"90th_percentile":21378.27}]}]},{"description":"Level 1 Therapeutic Radiation Treatment Preparation","code_information":[{"code":"5611","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8512.12,"10th_percentile":8512.12,"90th_percentile":8512.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5200.39,"10th_percentile":5200.39,"90th_percentile":5200.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Therapeutic Radiation Treatment Preparation","code_information":[{"code":"5612","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":31389.91,"10th_percentile":31389.91,"90th_percentile":31389.91},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":20755.04,"10th_percentile":20755.04,"90th_percentile":20755.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2456.32,"10th_percentile":857.8,"90th_percentile":6535.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":13394.09,"10th_percentile":3320.43,"90th_percentile":35067.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3995.88,"10th_percentile":1208.78,"90th_percentile":10512.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":1461.43,"10th_percentile":1461.43,"90th_percentile":38197.36},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":11231.93,"10th_percentile":11231.93,"90th_percentile":11231.93},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Therapeutic Radiation Treatment Preparation","code_information":[{"code":"5613","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3359.36,"10th_percentile":2591.58,"90th_percentile":10092.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"12","median_amount":32441.4,"10th_percentile":14751.94,"90th_percentile":62173.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5196.26,"10th_percentile":2413.9,"90th_percentile":10610.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":15099.97,"10th_percentile":15099.97,"90th_percentile":64226.12},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":62214.77,"10th_percentile":37853.12,"90th_percentile":66479.99},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"1 through 10","median_amount":15895.1,"10th_percentile":15895.1,"90th_percentile":15895.1}]}]},{"description":"Level 2 Radiation Therapy","code_information":[{"code":"5622","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":8263.3,"10th_percentile":8263.3,"90th_percentile":8263.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1264.19,"10th_percentile":1034.54,"90th_percentile":2586.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1544.13,"10th_percentile":1306.75,"90th_percentile":2613.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Radiation Therapy","code_information":[{"code":"5623","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":161.89,"10th_percentile":161.89,"90th_percentile":161.89},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8208.23,"10th_percentile":2540.08,"90th_percentile":10878.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":44138.7,"10th_percentile":15624.0,"90th_percentile":67356.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10566.76,"10th_percentile":2641.69,"90th_percentile":11577.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":7274.41,"10th_percentile":7274.41,"90th_percentile":17213.2},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":6878.96,"10th_percentile":3365.62,"90th_percentile":13462.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 6 Radiation Therapy","code_information":[{"code":"5626","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":33468.05,"10th_percentile":33468.05,"90th_percentile":33468.05},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9888.79,"10th_percentile":9888.79,"90th_percentile":9888.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":53493.3,"10th_percentile":53493.3,"90th_percentile":53493.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7751.41,"10th_percentile":7751.41,"90th_percentile":15935.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":40038.34,"10th_percentile":40038.34,"90th_percentile":60387.66},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":37156.05,"10th_percentile":37156.05,"90th_percentile":37156.05},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10833.7,"10th_percentile":10833.7,"90th_percentile":10833.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 7 Radiation Therapy","code_information":[{"code":"5627","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":20904.58,"10th_percentile":20904.58,"90th_percentile":20904.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Therapeutic Nuclear Medicine","code_information":[{"code":"5661","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":3540.55,"10th_percentile":3540.55,"90th_percentile":21154.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"1 through 10","median_amount":13617.76,"10th_percentile":13617.76,"90th_percentile":13617.76}]}]},{"description":"Level 1 Pathology","code_information":[{"code":"5671","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":13280.92,"10th_percentile":7037.71,"90th_percentile":18572.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"31","median_amount":3535.81,"10th_percentile":160.22,"90th_percentile":24168.93},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":4777.18,"10th_percentile":4132.45,"90th_percentile":10372.11},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"56","median_amount":3944.07,"10th_percentile":190.75,"90th_percentile":10712.21},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":364.89,"10th_percentile":190.75,"90th_percentile":8727.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"37","median_amount":907.91,"10th_percentile":51.18,"90th_percentile":3619.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"169","median_amount":2870.1,"10th_percentile":55.7,"90th_percentile":12606.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"78","median_amount":1287.03,"10th_percentile":58.32,"90th_percentile":3614.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"21","median_amount":5542.54,"10th_percentile":150.42,"90th_percentile":13593.56},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"20","median_amount":6046.21,"10th_percentile":1606.8,"90th_percentile":29916.69},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"14","median_amount":715.88,"10th_percentile":253.43,"90th_percentile":5515.07}]}]},{"description":"Level 2 Pathology","code_information":[{"code":"5672","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":2811.56,"10th_percentile":900.35,"90th_percentile":16200.65},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":5663.17,"10th_percentile":4897.63,"90th_percentile":9591.32},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":2294.67,"10th_percentile":553.71,"90th_percentile":14598.9},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":3784.83,"10th_percentile":3784.83,"90th_percentile":6288.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":935.05,"10th_percentile":179.86,"90th_percentile":1893.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"61","median_amount":3702.57,"10th_percentile":187.05,"90th_percentile":8183.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":5449.13,"10th_percentile":5449.13,"90th_percentile":5449.13},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"44","median_amount":1377.34,"10th_percentile":140.67,"90th_percentile":3681.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"1 through 10","median_amount":6531.57,"10th_percentile":6026.33,"90th_percentile":7797.4}]}]},{"description":"Level 3 Pathology","code_information":[{"code":"5673","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":12788.77,"10th_percentile":5525.17,"90th_percentile":32297.43},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":26602.87,"10th_percentile":10806.62,"90th_percentile":31061.04},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":29417.57,"10th_percentile":11448.7,"90th_percentile":32067.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1829.98,"10th_percentile":651.16,"90th_percentile":6457.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"28","median_amount":15532.11,"10th_percentile":778.5,"90th_percentile":48007.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":3760.04,"10th_percentile":3421.77,"90th_percentile":10676.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"1 through 10","median_amount":33733.67,"10th_percentile":4882.27,"90th_percentile":51286.37}]}]},{"description":"Level 4 Pathology","code_information":[{"code":"5674","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":33725.74,"10th_percentile":33725.74,"90th_percentile":33725.74},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8082.76,"10th_percentile":8082.76,"90th_percentile":8082.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":33116.86,"10th_percentile":33116.86,"90th_percentile":33116.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":21353.8,"10th_percentile":21353.8,"90th_percentile":21353.8},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":45042.23,"10th_percentile":45042.23,"90th_percentile":45042.23},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Drug Administration","code_information":[{"code":"5691","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":11519.22,"10th_percentile":11519.22,"90th_percentile":11519.22},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":543.04,"10th_percentile":543.04,"90th_percentile":543.04},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":187.88,"10th_percentile":179.66,"90th_percentile":187.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":15937.15,"10th_percentile":10102.18,"90th_percentile":32633.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":8545.52,"10th_percentile":111.73,"90th_percentile":10830.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":12785.43,"10th_percentile":12785.43,"90th_percentile":12785.43},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":254.51,"10th_percentile":141.91,"90th_percentile":5560.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"135","median_amount":3789.82,"10th_percentile":538.72,"90th_percentile":25695.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"22","median_amount":891.24,"10th_percentile":489.92,"90th_percentile":25532.02},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":896.9,"10th_percentile":717.57,"90th_percentile":8576.81},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"43","median_amount":1192.03,"10th_percentile":524.12,"90th_percentile":11172.97}]}]},{"description":"Level 4 Drug Administration","code_information":[{"code":"5694","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":19595.08,"10th_percentile":17123.51,"90th_percentile":69723.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"18","median_amount":5492.88,"10th_percentile":1884.57,"90th_percentile":28247.41},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"81","median_amount":800.63,"10th_percentile":592.9,"90th_percentile":11392.98},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":26737.42,"10th_percentile":26737.42,"90th_percentile":26737.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"81","median_amount":703.27,"10th_percentile":278.51,"90th_percentile":9445.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"223","median_amount":7389.08,"10th_percentile":1367.28,"90th_percentile":33563.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"188","median_amount":1325.35,"10th_percentile":370.24,"90th_percentile":15769.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"45","median_amount":16190.19,"10th_percentile":4354.01,"90th_percentile":32460.47},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"41","median_amount":13562.87,"10th_percentile":2798.63,"90th_percentile":39314.82},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"37","median_amount":6408.95,"10th_percentile":1527.36,"90th_percentile":44295.89}]}]},{"description":"Level 1 Diagnostic Tests and Related Services","code_information":[{"code":"5721","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":192.42,"10th_percentile":192.42,"90th_percentile":201.95},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":217.03,"10th_percentile":217.03,"90th_percentile":217.03},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":115.22,"10th_percentile":115.22,"90th_percentile":167.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":71.26,"10th_percentile":49.07,"90th_percentile":135.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":170.78,"10th_percentile":170.78,"90th_percentile":170.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":245.87,"10th_percentile":245.87,"90th_percentile":245.87},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"1 through 10","median_amount":173.98,"10th_percentile":173.98,"90th_percentile":173.98}]}]},{"description":"Level 2 Diagnostic Tests and Related Services","code_information":[{"code":"5722","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":532.53,"10th_percentile":532.53,"90th_percentile":532.53},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":1046.5,"10th_percentile":1046.5,"90th_percentile":1046.5},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":250.95,"10th_percentile":250.95,"90th_percentile":250.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":316.84,"10th_percentile":316.84,"90th_percentile":316.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":65.36,"10th_percentile":45.75,"90th_percentile":143.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":454.96,"10th_percentile":246.81,"90th_percentile":1735.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":745.89,"10th_percentile":745.89,"90th_percentile":745.89},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":778.32,"10th_percentile":778.32,"90th_percentile":778.32},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Diagnostic Tests and Related Services","code_information":[{"code":"5723","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":2267.85,"10th_percentile":2267.85,"90th_percentile":2519.83},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":652.41,"10th_percentile":652.41,"90th_percentile":652.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":1187.78,"10th_percentile":1040.81,"90th_percentile":1319.75},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":1121.79,"10th_percentile":1121.79,"90th_percentile":1179.59},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":923.83,"10th_percentile":692.8,"90th_percentile":2494.83},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"14","median_amount":1018.83,"10th_percentile":969.83,"90th_percentile":1067.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"37","median_amount":705.63,"10th_percentile":553.86,"90th_percentile":2859.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"43","median_amount":1017.44,"10th_percentile":296.73,"90th_percentile":1115.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":957.55,"10th_percentile":743.14,"90th_percentile":2624.41},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":2595.96,"10th_percentile":2595.96,"90th_percentile":2595.96},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"1 through 10","median_amount":1032.49,"10th_percentile":752.49,"90th_percentile":1290.61}]}]},{"description":"Level 1 Minor Procedures","code_information":[{"code":"5731","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":2958.32,"10th_percentile":2958.32,"90th_percentile":2958.32},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":55.57,"10th_percentile":55.57,"90th_percentile":55.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":500.44,"10th_percentile":500.44,"90th_percentile":500.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":393.0,"10th_percentile":276.71,"90th_percentile":604.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":185.08,"10th_percentile":67.05,"90th_percentile":469.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"1 through 10","median_amount":3182.2,"10th_percentile":2202.68,"90th_percentile":4405.37}]}]},{"description":"Level 2 Minor Procedures","code_information":[{"code":"5732","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8595.0,"10th_percentile":8595.0,"90th_percentile":8595.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":11320.91,"10th_percentile":11320.91,"90th_percentile":11320.91},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":8541.23,"10th_percentile":8541.23,"90th_percentile":8541.23},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":8585.42,"10th_percentile":8585.42,"90th_percentile":8585.42},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":6184.88,"10th_percentile":6184.88,"90th_percentile":6184.88},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":9407.68,"10th_percentile":7764.27,"90th_percentile":18424.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Minor Procedures","code_information":[{"code":"5733","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":178.14,"10th_percentile":178.14,"90th_percentile":178.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":72.0,"10th_percentile":72.0,"90th_percentile":263.03},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":81.37,"10th_percentile":21.73,"90th_percentile":228.9},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":113.33,"10th_percentile":113.33,"90th_percentile":113.33},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"20","median_amount":13.35,"10th_percentile":7.6,"90th_percentile":63.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"31","median_amount":34.32,"10th_percentile":10.1,"90th_percentile":341.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"41","median_amount":18.68,"10th_percentile":7.68,"90th_percentile":81.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":8169.44,"10th_percentile":8169.44,"90th_percentile":8169.44},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":86.4,"10th_percentile":86.4,"90th_percentile":86.4},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"1 through 10","median_amount":89.28,"10th_percentile":89.28,"90th_percentile":6991.51}]}]},{"description":"Level 4 Minor Procedures","code_information":[{"code":"5734","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":352.87,"10th_percentile":67.79,"90th_percentile":423.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":423.6,"10th_percentile":289.92,"90th_percentile":814.92},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":315.56,"10th_percentile":315.56,"90th_percentile":315.56},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"37","median_amount":573.32,"10th_percentile":223.14,"90th_percentile":897.44},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":732.06,"10th_percentile":289.29,"90th_percentile":845.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"14","median_amount":86.29,"10th_percentile":12.05,"90th_percentile":130.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"144","median_amount":120.62,"10th_percentile":41.31,"90th_percentile":523.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"47","median_amount":140.7,"10th_percentile":81.9,"90th_percentile":140.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"14","median_amount":486.68,"10th_percentile":131.1,"90th_percentile":598.1},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"19","median_amount":862.91,"10th_percentile":300.83,"90th_percentile":6013.18},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"23","median_amount":630.06,"10th_percentile":300.02,"90th_percentile":972.53}]}]},{"description":"Level 5 Minor Procedures","code_information":[{"code":"5735","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Electronic Analysis of Devices","code_information":[{"code":"5741","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8.62,"10th_percentile":8.62,"90th_percentile":8.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"11","median_amount":1330.65,"10th_percentile":633.46,"90th_percentile":2623.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"16","median_amount":324.12,"10th_percentile":108.04,"90th_percentile":972.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":840.54,"10th_percentile":420.27,"90th_percentile":1681.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"1 through 10","median_amount":1053.33,"10th_percentile":1053.33,"90th_percentile":1429.63}]}]},{"description":"Resuscitation and Cardioversion","code_information":[{"code":"5781","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":5694.55,"10th_percentile":5694.55,"90th_percentile":5694.55},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":2375.81,"10th_percentile":2375.81,"90th_percentile":2375.81},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":637.82,"10th_percentile":637.82,"90th_percentile":1530.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":4110.07,"10th_percentile":2498.7,"90th_percentile":6453.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":292.89,"10th_percentile":292.89,"90th_percentile":1050.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":2675.09,"10th_percentile":2675.09,"90th_percentile":2675.09},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":2061.9,"10th_percentile":2061.9,"90th_percentile":5777.37},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"1 through 10","median_amount":2740.48,"10th_percentile":2740.48,"90th_percentile":2740.48}]}]},{"description":"Pulmonary Treatment","code_information":[{"code":"5791","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1176.94,"10th_percentile":1176.94,"90th_percentile":1176.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":1624.45,"10th_percentile":1624.45,"90th_percentile":1624.45},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":459.61,"10th_percentile":291.69,"90th_percentile":730.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"1 through 10","median_amount":360.74,"10th_percentile":360.74,"90th_percentile":360.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"1 through 10","median_amount":882.28,"10th_percentile":882.28,"90th_percentile":882.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Manipulation Therapy","code_information":[{"code":"5811","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":47.57,"10th_percentile":47.57,"90th_percentile":140.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":143.38,"10th_percentile":143.38,"90th_percentile":157.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Health and Behavior Services","code_information":[{"code":"5821","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":41.61,"10th_percentile":41.61,"90th_percentile":41.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":299.33,"10th_percentile":299.33,"90th_percentile":299.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Health and Behavior Services","code_information":[{"code":"5822","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":61.23,"10th_percentile":61.23,"90th_percentile":61.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":62.88,"10th_percentile":62.88,"90th_percentile":114.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":136.89,"10th_percentile":110.0,"90th_percentile":424.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Health and Behavior Services","code_information":[{"code":"5823","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":218.02,"10th_percentile":218.02,"90th_percentile":306.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":297.64,"10th_percentile":297.64,"90th_percentile":297.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Injection, fulphila","code_information":[{"code":"9173","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":1963.05,"10th_percentile":1963.05,"90th_percentile":1963.05},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. Available, referenceable Tricare logic found here: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1555.18,"10th_percentile":1555.18,"90th_percentile":1555.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Platelets pheresis path redu","code_information":[{"code":"9536","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":2207.26,"10th_percentile":2207.26,"90th_percentile":2207.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1806.89,"10th_percentile":1806.89,"90th_percentile":1806.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-OPPS Clinic Services","code_information":[{"code":"N700","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":338.0,"10th_percentile":338.0,"90th_percentile":338.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":101.45,"10th_percentile":96.82,"90th_percentile":300.0},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":212.94,"10th_percentile":212.94,"90th_percentile":236.6},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":140.67,"10th_percentile":140.67,"90th_percentile":140.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"19","median_amount":300.96,"10th_percentile":124.44,"90th_percentile":310.96},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"17","median_amount":234.2,"10th_percentile":121.73,"90th_percentile":234.2},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":135.26,"10th_percentile":135.26,"90th_percentile":135.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"18","median_amount":251.47,"10th_percentile":75.0,"90th_percentile":314.34}]}]},{"description":"Clinical Diagnostic Lab Services","code_information":[{"code":"N800","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":116.01,"10th_percentile":116.01,"90th_percentile":116.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"89","median_amount":169.55,"10th_percentile":32.44,"90th_percentile":361.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"432","median_amount":186.13,"10th_percentile":37.49,"90th_percentile":550.88},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"147","median_amount":251.39,"10th_percentile":79.05,"90th_percentile":860.84},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1313","median_amount":266.19,"10th_percentile":75.61,"90th_percentile":588.56},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"120","median_amount":207.03,"10th_percentile":71.05,"90th_percentile":536.36},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"688","median_amount":38.36,"10th_percentile":5.45,"90th_percentile":98.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"2998","median_amount":64.69,"10th_percentile":15.34,"90th_percentile":174.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":310.06,"10th_percentile":289.32,"90th_percentile":1281.41},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1693","median_amount":40.34,"10th_percentile":8.62,"90th_percentile":101.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"308","median_amount":317.63,"10th_percentile":99.48,"90th_percentile":567.64},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"396","median_amount":343.36,"10th_percentile":94.51,"90th_percentile":626.41},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"140","median_amount":330.75,"10th_percentile":134.28,"90th_percentile":823.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":1789.2,"10th_percentile":1789.2,"90th_percentile":1789.2},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"91","median_amount":125.28,"10th_percentile":33.72,"90th_percentile":337.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"13","median_amount":537.74,"10th_percentile":277.39,"90th_percentile":1773.76},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":171.0,"10th_percentile":151.92,"90th_percentile":749.69},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"87","median_amount":316.06,"10th_percentile":310.5,"90th_percentile":372.6},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"146","median_amount":289.8,"10th_percentile":289.8,"90th_percentile":289.8},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"12","median_amount":289.8,"10th_percentile":289.8,"90th_percentile":289.8},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"45","median_amount":110.62,"10th_percentile":110.62,"90th_percentile":110.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"522","median_amount":372.6,"10th_percentile":360.18,"90th_percentile":372.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":822.94,"10th_percentile":822.94,"90th_percentile":822.94},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"155","median_amount":115.05,"10th_percentile":115.05,"90th_percentile":115.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"60","median_amount":380.88,"10th_percentile":380.88,"90th_percentile":380.88},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"97","median_amount":372.6,"10th_percentile":372.6,"90th_percentile":372.6},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"73","median_amount":385.02,"10th_percentile":250.0,"90th_percentile":385.02}]}]},{"description":"Non-covered Services","code_information":[{"code":"N900","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":345.94,"10th_percentile":345.94,"90th_percentile":345.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":558.91,"10th_percentile":558.91,"90th_percentile":558.91},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"12","median_amount":376.08,"10th_percentile":376.08,"90th_percentile":434.71},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":434.71,"10th_percentile":434.71,"90th_percentile":434.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":72.08,"10th_percentile":49.26,"90th_percentile":121.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"43","median_amount":483.53,"10th_percentile":376.08,"90th_percentile":558.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"19","median_amount":125.92,"10th_percentile":102.18,"90th_percentile":126.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":428.49,"10th_percentile":370.7,"90th_percentile":571.32},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":558.91,"10th_percentile":483.53,"90th_percentile":558.91},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":93.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Packaged Services","code_information":[{"code":"N902","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"6 Degrees Of Health","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia & Maco Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Montana Kids Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":1854.91,"10th_percentile":1854.91,"90th_percentile":1854.91},{"payer_name":"Bcbs","plan_name":"Logan Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":428.05,"10th_percentile":288.75,"90th_percentile":909.13},{"payer_name":"Bcbs","plan_name":"Logan Union Employee","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":182.08,"10th_percentile":182.08,"90th_percentile":182.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): FEE SCHEDULE] [All Other OP (%BC): 90]","count":"14","median_amount":125.96,"10th_percentile":23.49,"90th_percentile":1211.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Choice Health","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6742.42,"10th_percentile":6742.42,"90th_percentile":6742.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Mountain Health Co-Op","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":2376.36,"10th_percentile":2376.36,"90th_percentile":2376.36},{"payer_name":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Tricare West","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 85] [Outpatient Services: Payer leverages Tricare methodology. 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