{"hospital_name":"Stillwater Billings Clinic","last_updated_on":"2026-04-01","version":"3.0.0","location_name":["Stillwater Billings Clinic"],"hospital_address":["710 N 11Th St, Columbus, MT 59019"],"license_information":{"license_number":"13418 ","state":"MT"},"type_2_npi":["1053488387"],"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":"Erica Wright"},"modifier_information":[{"description":"Repeat Clinical Diagnostic Laboratory Test","code":"91","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allegiance","plan_name":"MMIA","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":"BCBS MT","plan_name":"Blue Focus","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"Blue Options","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health Network","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mountain Health Co-op","plan_name":"Peak PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"PacificSource","plan_name":"Medicare Advantage","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":"United Healthcare","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":"Aetna","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allegiance","plan_name":"MMIA","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":"BCBS MT","plan_name":"Blue Focus","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"Blue Options","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health Network","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mountain Health Co-op","plan_name":"Peak PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"PacificSource","plan_name":"Medicare Advantage","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":"United Healthcare","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":"Aetna","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allegiance","plan_name":"MMIA","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":"BCBS MT","plan_name":"Blue Focus","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"Blue Options","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health Network","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mountain Health Co-op","plan_name":"Peak PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"PacificSource","plan_name":"Medicare Advantage","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":"United Healthcare","plan_name":"PPO","description":"The modified price is presented in the standard charge value."}]},{"description":"Professional Component","code":"26","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allegiance","plan_name":"MMIA","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":"BCBS MT","plan_name":"Blue Focus","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"Blue Options","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health Network","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mountain Health Co-op","plan_name":"Peak PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"PacificSource","plan_name":"Medicare Advantage","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":"United Healthcare","plan_name":"PPO","description":"The modified price is presented in the standard charge value."}]},{"description":"Left side (used to identify procedures performed on the left side of the body)","code":"LT","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allegiance","plan_name":"MMIA","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":"BCBS MT","plan_name":"Blue Focus","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"Blue Options","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health Network","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mountain Health Co-op","plan_name":"Peak PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"PacificSource","plan_name":"Medicare Advantage","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":"United Healthcare","plan_name":"PPO","description":"The modified price is presented in the standard charge value."}]},{"description":"Right side (used to identify procedures performed on the right side of the body)","code":"RT","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allegiance","plan_name":"MMIA","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":"BCBS MT","plan_name":"Blue Focus","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"Blue Options","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health Network","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mountain Health Co-op","plan_name":"Peak PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"PacificSource","plan_name":"Medicare Advantage","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":"United Healthcare","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":"Aetna","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allegiance","plan_name":"MMIA","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":"BCBS MT","plan_name":"Blue Focus","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"Blue Options","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health Network","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mountain Health Co-op","plan_name":"Peak PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"PacificSource","plan_name":"Medicare Advantage","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":"United Healthcare","plan_name":"PPO","description":"The modified price is presented in the standard charge value."}]},{"description":"Clia waived test","code":"QW","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allegiance","plan_name":"MMIA","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":"BCBS MT","plan_name":"Blue Focus","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"Blue Options","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health Network","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mountain Health Co-op","plan_name":"Peak PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"PacificSource","plan_name":"Medicare Advantage","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":"United Healthcare","plan_name":"PPO","description":"The modified price is presented in the standard charge value."}]},{"description":"Bilateral Procedure","code":"50","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allegiance","plan_name":"MMIA","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":"BCBS MT","plan_name":"Blue Focus","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"Blue Options","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health Network","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mountain Health Co-op","plan_name":"Peak PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"PacificSource","plan_name":"Medicare Advantage","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":"United Healthcare","plan_name":"PPO","description":"The modified price is presented in the standard charge value."}]},{"description":"Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit","code":"GY","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allegiance","plan_name":"MMIA","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":"BCBS MT","plan_name":"Blue Focus","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"Blue Options","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health Network","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mountain Health Co-op","plan_name":"Peak PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"PacificSource","plan_name":"Medicare Advantage","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":"United Healthcare","plan_name":"PPO","description":"The modified price is presented in the standard charge value."}]},{"description":"State supplied vaccine","code":"SL","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allegiance","plan_name":"MMIA","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":"BCBS MT","plan_name":"Blue Focus","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"Blue Options","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health Network","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mountain Health Co-op","plan_name":"Peak PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"PacificSource","plan_name":"Medicare Advantage","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":"United Healthcare","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":"Aetna","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allegiance","plan_name":"MMIA","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":"BCBS MT","plan_name":"Blue Focus","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"Blue Options","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health Network","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mountain Health Co-op","plan_name":"Peak PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"PacificSource","plan_name":"Medicare Advantage","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":"United Healthcare","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":"Aetna","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allegiance","plan_name":"MMIA","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":"BCBS MT","plan_name":"Blue Focus","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"Blue Options","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health Network","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mountain Health Co-op","plan_name":"Peak PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"PacificSource","plan_name":"Medicare Advantage","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":"United Healthcare","plan_name":"PPO","description":"The modified price is presented in the standard charge value."}]},{"description":"Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes","code":"TB","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allegiance","plan_name":"MMIA","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":"BCBS MT","plan_name":"Blue Focus","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"Blue Options","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health Network","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mountain Health Co-op","plan_name":"Peak PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"PacificSource","plan_name":"Medicare Advantage","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":"United Healthcare","plan_name":"PPO","description":"The modified price is presented in the standard charge value."}]},{"description":"Administered subcutaneously","code":"JB","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allegiance","plan_name":"MMIA","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":"BCBS MT","plan_name":"Blue Focus","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"Blue Options","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS MT","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health Network","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mountain Health Co-op","plan_name":"Peak PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"PacificSource","plan_name":"Medicare Advantage","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":"United Healthcare","plan_name":"PPO","description":"The modified price is presented in the standard charge value."}]},{"description":"Reduced 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures With Mcc","code_information":[{"code":"031","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age 0-17","code_information":[{"code":"048","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures","code_information":[{"code":"049","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sialoadenectomy","code_information":[{"code":"050","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Salivary Gland Procedures Except Sialoadenectomy","code_information":[{"code":"051","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Disorders And Injuries With Cc/Mcc","code_information":[{"code":"052","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Disorders And Injuries Without Cc/Mcc","code_information":[{"code":"053","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nervous System Neoplasms With Mcc","code_information":[{"code":"054","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nervous System Neoplasms Without Mcc","code_information":[{"code":"055","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Degenerative Nervous System Disorders With Mcc","code_information":[{"code":"056","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":76704.2,"10th_percentile":76704.2,"90th_percentile":76704.2,"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":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Cc","code_information":[{"code":"059","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":29162.44,"10th_percentile":29162.44,"90th_percentile":29162.44,"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":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","code_information":[{"code":"060","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","code_information":[{"code":"061","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","code_information":[{"code":"064","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Precerebral Occlusion Without Infarction With Mcc","code_information":[{"code":"067","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transient Ischemia Without Thrombolytic","code_information":[{"code":"069","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders With Mcc","code_information":[{"code":"070","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders With Cc","code_information":[{"code":"071","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders Without Cc/Mcc","code_information":[{"code":"072","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial And Peripheral Nerve Disorders With Mcc","code_information":[{"code":"073","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy With Mcc","code_information":[{"code":"077","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"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":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"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":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"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":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With Mcc","code_information":[{"code":"085","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With Cc","code_information":[{"code":"086","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion With Mcc","code_information":[{"code":"088","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion With Cc","code_information":[{"code":"089","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion Without Cc/Mcc","code_information":[{"code":"090","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System With Mcc","code_information":[{"code":"091","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":23200.5,"10th_percentile":23200.5,"90th_percentile":23200.5,"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":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System With Cc","code_information":[{"code":"092","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System Without Cc/Mcc","code_information":[{"code":"093","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Mcc","code_information":[{"code":"094","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Cc","code_information":[{"code":"095","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","code_information":[{"code":"096","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","code_information":[{"code":"097","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","code_information":[{"code":"098","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Seizures With Mcc","code_information":[{"code":"100","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Seizures Without Mcc","code_information":[{"code":"101","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Headaches Without Mcc","code_information":[{"code":"103","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","code_information":[{"code":"105","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass w PTCA","code_information":[{"code":"106","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"107","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures","code_information":[{"code":"108","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"109","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Cardiovascular Procedures w CC","code_information":[{"code":"110","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Cardiovascular Procedures w/o CC","code_information":[{"code":"111","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"112","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Orbital Procedures With Cc/Mcc","code_information":[{"code":"113","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Orbital Procedures Without Cc/Mcc","code_information":[{"code":"114","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures Without Cc/Mcc","code_information":[{"code":"165","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms With Mcc","code_information":[{"code":"180","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms With Cc","code_information":[{"code":"181","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma With Mcc","code_information":[{"code":"183","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion With Mcc","code_information":[{"code":"186","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion With Cc","code_information":[{"code":"187","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion Without Cc/Mcc","code_information":[{"code":"188","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Edema And Respiratory Failure","code_information":[{"code":"189","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Cc","code_information":[{"code":"191","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","code_information":[{"code":"192","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy With Mcc","code_information":[{"code":"193","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":7555.8,"10th_percentile":7555.8,"90th_percentile":7555.8,"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":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease With Mcc","code_information":[{"code":"196","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease With Cc","code_information":[{"code":"197","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax With Mcc","code_information":[{"code":"199","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory System Diagnosis With Ventilator Support <=96 Hours","code_information":[{"code":"208","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complex Aortic Arch Procedures","code_information":[{"code":"209","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip & Femur Procedures Except Major Joint Age >17 w CC","code_information":[{"code":"210","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip & Femur Procedures Except Major Joint Age >17 w/o CC","code_information":[{"code":"211","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concomitant Aortic And Mitral Valve Procedures","code_information":[{"code":"212","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Abdominal Aorta With Iliac Branch Procedures","code_information":[{"code":"213","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major cardiovasc procedures w/o MCC","code_information":[{"code":"238","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Procedures","code_information":[{"code":"264","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","code_information":[{"code":"269","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired With Mcc","code_information":[{"code":"283","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired With Cc","code_information":[{"code":"284","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired Without Cc/Mcc","code_information":[{"code":"285","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","code_information":[{"code":"286","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","code_information":[{"code":"287","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis With Cc","code_information":[{"code":"289","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis Without Cc/Mcc","code_information":[{"code":"290","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock With Mcc","code_information":[{"code":"291","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":8520.35,"10th_percentile":8520.35,"90th_percentile":8520.35,"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":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis With Cc/Mcc","code_information":[{"code":"294","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis Without Cc/Mcc","code_information":[{"code":"295","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained With Mcc","code_information":[{"code":"296","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained With Cc","code_information":[{"code":"297","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained Without Cc/Mcc","code_information":[{"code":"298","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders With Mcc","code_information":[{"code":"299","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders With Cc","code_information":[{"code":"300","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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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":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Atherosclerosis With Mcc","code_information":[{"code":"302","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Atherosclerosis Without Mcc","code_information":[{"code":"303","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertension With Mcc","code_information":[{"code":"304","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertension Without Mcc","code_information":[{"code":"305","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Mcc","code_information":[{"code":"308","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Cc","code_information":[{"code":"309","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","code_information":[{"code":"310","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Angina Pectoris","code_information":[{"code":"311","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endovascular Cardiac Valve Procedures With Mcc","code_information":[{"code":"319","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endovascular Cardiac Valve Procedures Without Mcc","code_information":[{"code":"320","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","code_information":[{"code":"321","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","code_information":[{"code":"324","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy Without Intraluminal Device","code_information":[{"code":"325","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endoscopic Tubal Interruption","code_information":[{"code":"362","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System w/o CC","code_information":[{"code":"367","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uncomplicated Peptic Ulcer With Mcc","code_information":[{"code":"383","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uncomplicated Peptic Ulcer Without Mcc","code_information":[{"code":"384","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease With Mcc","code_information":[{"code":"385","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease With Cc","code_information":[{"code":"386","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease Without Cc/Mcc","code_information":[{"code":"387","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction With Mcc","code_information":[{"code":"388","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction With Cc","code_information":[{"code":"389","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":37671.25,"10th_percentile":37671.25,"90th_percentile":37671.25,"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":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction Without Cc/Mcc","code_information":[{"code":"390","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","code_information":[{"code":"391","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","code_information":[{"code":"392","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":6688.88,"10th_percentile":6688.88,"90th_percentile":6688.88}]}]},{"description":"Other Digestive System Diagnoses With Mcc","code_information":[{"code":"393","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses With Cc","code_information":[{"code":"394","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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With Cc","code_information":[{"code":"409","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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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":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","code_information":[{"code":"441","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","code_information":[{"code":"442","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"443","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract With Mcc","code_information":[{"code":"444","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"448","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning & toxic Effects of Drugs Age >17 w CC","code_information":[{"code":"449","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F","code_information":[{"code":"450","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","code_information":[{"code":"507","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Arthroscopy","code_information":[{"code":"509","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc","code_information":[{"code":"511","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","code_information":[{"code":"513","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","code_information":[{"code":"517","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis With Cc","code_information":[{"code":"549","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis Without Cc/Mcc","code_information":[{"code":"550","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Medical Back Problems With Mcc","code_information":[{"code":"551","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Medical Back Problems Without Mcc","code_information":[{"code":"552","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone Diseases And Arthropathies With Mcc","code_information":[{"code":"553","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone Diseases And Arthropathies Without Mcc","code_information":[{"code":"554","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"555","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","code_information":[{"code":"556","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tendonitis, Myositis And Bursitis With Mcc","code_information":[{"code":"557","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tendonitis, Myositis And Bursitis Without Mcc","code_information":[{"code":"558","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"559","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"560","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":21208.2,"10th_percentile":21208.2,"90th_percentile":21208.2,"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":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":51835.7,"10th_percentile":51835.7,"90th_percentile":51835.7,"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":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"561","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":46423.94,"10th_percentile":46423.94,"90th_percentile":46423.94,"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":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","code_information":[{"code":"562","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx","code_information":[{"code":"568","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement With Mcc","code_information":[{"code":"570","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement With Cc","code_information":[{"code":"571","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement Without Cc/Mcc","code_information":[{"code":"572","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis With Mcc","code_information":[{"code":"573","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis With Cc","code_information":[{"code":"574","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc","code_information":[{"code":"575","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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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":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes Without Cc/Mcc","code_information":[{"code":"639","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","code_information":[{"code":"743","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","code_information":[{"code":"744","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vagina, Cervix And Vulva Procedures With Cc/Mcc","code_information":[{"code":"746","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vagina, Cervix And Vulva Procedures Without Cc/Mcc","code_information":[{"code":"747","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Female Reproductive System Reconstructive Procedures","code_information":[{"code":"748","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System With Cc","code_information":[{"code":"755","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System Without Cc/Mcc","code_information":[{"code":"756","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System With Mcc","code_information":[{"code":"757","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Procedures","code_information":[{"code":"769","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Abortion With D&C, Aspiration Curettage Or Hysterotomy","code_information":[{"code":"770","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ectopic Pregnancy","code_information":[{"code":"777","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Illness Without Mcc","code_information":[{"code":"866","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses With Mcc","code_information":[{"code":"867","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses With Cc","code_information":[{"code":"868","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc","code_information":[{"code":"869","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis With Mv >96 Hours","code_information":[{"code":"870","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","code_information":[{"code":"871","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":11489.2,"10th_percentile":11489.2,"90th_percentile":11489.2,"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":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Principal Diagnosis Of Mental Illness","code_information":[{"code":"876","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Adjustment Reaction And Psychosocial Dysfunction","code_information":[{"code":"880","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Depressive Neuroses","code_information":[{"code":"881","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":2210.41,"10th_percentile":2210.41,"90th_percentile":2210.41},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neuroses Except Depressive","code_information":[{"code":"882","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Personality And Impulse Control","code_information":[{"code":"883","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Organic Disturbances And Intellectual Disability","code_information":[{"code":"884","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Psychoses","code_information":[{"code":"885","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Behavioral And Developmental Disorders","code_information":[{"code":"886","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Mental Disorder Diagnoses","code_information":[{"code":"887","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries With Mcc","code_information":[{"code":"901","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries With Cc","code_information":[{"code":"902","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries Without Cc/Mcc","code_information":[{"code":"903","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts For Injuries With Cc/Mcc","code_information":[{"code":"904","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts For Injuries Without Cc/Mcc","code_information":[{"code":"905","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Procedures For Injuries","code_information":[{"code":"906","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries With Mcc","code_information":[{"code":"907","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries With Cc","code_information":[{"code":"908","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries Without Cc/Mcc","code_information":[{"code":"909","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Injury With Mcc","code_information":[{"code":"913","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Injury Without Mcc","code_information":[{"code":"914","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allergic Reactions With Mcc","code_information":[{"code":"915","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allergic Reactions Without Mcc","code_information":[{"code":"916","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning And Toxic Effects Of Drugs With Mcc","code_information":[{"code":"917","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning And Toxic Effects Of Drugs Without Mcc","code_information":[{"code":"918","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment With Mcc","code_information":[{"code":"919","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment With Cc","code_information":[{"code":"920","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment Without Cc/Mcc","code_information":[{"code":"921","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","code_information":[{"code":"922","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc","code_information":[{"code":"923","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft","code_information":[{"code":"927","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc","code_information":[{"code":"928","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc","code_information":[{"code":"929","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft","code_information":[{"code":"933","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn Without Skin Graft Or Inhalation Injury","code_information":[{"code":"934","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive Burns","code_information":[{"code":"935","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc","code_information":[{"code":"939","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc","code_information":[{"code":"940","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc","code_information":[{"code":"941","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rehabilitation With Cc/Mcc","code_information":[{"code":"945","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rehabilitation Without Cc/Mcc","code_information":[{"code":"946","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms With Mcc","code_information":[{"code":"947","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Without Mcc","code_information":[{"code":"948","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":20361.44,"10th_percentile":20361.44,"90th_percentile":35044.76,"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":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare With Cc/Mcc","code_information":[{"code":"949","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":118109.53,"10th_percentile":118109.53,"90th_percentile":118109.53,"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":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare Without Cc/Mcc","code_information":[{"code":"950","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Factors Influencing Health Status","code_information":[{"code":"951","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy For Multiple Significant Trauma","code_information":[{"code":"955","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","code_information":[{"code":"956","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma With Mcc","code_information":[{"code":"963","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma With Cc","code_information":[{"code":"964","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma Without Cc/Mcc","code_information":[{"code":"965","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Extensive O.R. Procedures With Mcc","code_information":[{"code":"969","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Extensive O.R. Procedures Without Mcc","code_information":[{"code":"970","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition With Mcc","code_information":[{"code":"974","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition With Cc","code_information":[{"code":"975","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition Without Cc/Mcc","code_information":[{"code":"976","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Or Without Other Related Condition","code_information":[{"code":"977","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inj, methylpred acetate 1 mg","code_information":[{"code":"0790","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 95] [Observation (%BC): 95] [Emergency Department (%BC): 95] [Cardiac Rehabilitation Therapy (%BC): 95] [Cardiac Stress Test (%BC): 95] [Cardiology (%BC): 95] [Echocardiology (%BC): 95] [EKG/ECG  (%BC): 95] [Electrophysiology (%BC): 95] [Electrophysiologic Ablation (%BC): 95] [Electrophysiology and Mapping Studies (%BC): 95] [Holter Monitor/Telemetry (%BC): 95] [Other Cardiac Testing (%BC): 95] [Peripheral Vascular Lab (%BC): 95] [EEG (%BC): 95] [EMG (%BC): 95] [MEG (%BC): 95] [Neuropsychological Testing and Biofeedback (%BC): 95] [Sleep Studies (%BC): 95] [Chemotherapy (%BC): 95] [Gamma Knife (%BC): 95] [Nuclear Medicine (%BC): 95] [Oncology (%BC): 95] [Radiation Therapy  (%BC): 95] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 95] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 95] [Occupational Therapy (%BC): 95] [Physical Therapy (%BC): 95] [Respiratory Services/Therapy  (%BC): 95] [Speech Therapy (%BC): 95] [Mental Health (%BC): 95] [OP ECT Mental Health (%BC): 95] [OP High Cost Drugs (%BC): 95] [Other Outpatient Implant (%BC): 95] [Hyperbarics (%BC): 95] [IV Therapy (%BC): 95] [Pulmonary Function (%BC): 95] [Pulmonary Rehabilitation (%BC): 95] [Trauma (%BC): 95] [All Other OP (%BC): 95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 100] [Observation (%BC): 100] [Emergency Department (%BC): 100] [Cardiac Rehabilitation Therapy (%BC): 100] [Cardiac Stress Test (%BC): 100] [Cardiology (%BC): 100] [Echocardiology (%BC): 100] [EKG/ECG  (%BC): 100] [Electrophysiology (%BC): 100] [Electrophysiologic Ablation (%BC): 100] [Electrophysiology and Mapping Studies (%BC): 100] [Holter Monitor/Telemetry (%BC): 100] [Other Cardiac Testing (%BC): 100] [Peripheral Vascular Lab (%BC): 100] [EEG (%BC): 100] [EMG (%BC): 100] [MEG (%BC): 100] [Neuropsychological Testing and Biofeedback (%BC): 100] [Sleep Studies (%BC): 100] [Chemotherapy (%BC): 100] [Gamma Knife (%BC): 100] [Nuclear Medicine (%BC): 100] [Oncology (%BC): 100] [Radiation Therapy  (%BC): 100] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 100] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 100] [Occupational Therapy (%BC): 100] [Physical Therapy (%BC): 100] [Respiratory Services/Therapy  (%BC): 100] [Speech Therapy (%BC): 100] [Mental Health (%BC): 100] [OP ECT Mental Health (%BC): 100] [OP High Cost Drugs (%BC): 100] [Other Outpatient Implant (%BC): 100] [Hyperbarics (%BC): 100] [IV Therapy (%BC): 100] [Pulmonary Function (%BC): 100] [Pulmonary Rehabilitation (%BC): 100] [Trauma (%BC): 100] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health Network","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":134.3,"10th_percentile":134.3,"90th_percentile":134.3,"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":"Mountain Health Co-Op","plan_name":"Peak 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Clinic Visits and Related Services","code_information":[{"code":"5012","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":57.0,"10th_percentile":57.0,"90th_percentile":57.0,"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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Focus","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":395.88,"10th_percentile":395.88,"90th_percentile":395.88},{"payer_name":"Bcbs Mt","plan_name":"Blue Options","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"122","median_amount":259.4,"10th_percentile":242.2,"90th_percentile":307.8,"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":"Bcbs Mt","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 95] [Observation (%BC): 95] [Emergency Department (%BC): 95] [Cardiac Rehabilitation Therapy (%BC): 95] [Cardiac Stress Test (%BC): 95] [Cardiology (%BC): 95] [Echocardiology (%BC): 95] [EKG/ECG  (%BC): 95] [Electrophysiology (%BC): 95] [Electrophysiologic Ablation (%BC): 95] [Electrophysiology and Mapping Studies (%BC): 95] [Holter Monitor/Telemetry (%BC): 95] [Other Cardiac Testing (%BC): 95] [Peripheral Vascular Lab (%BC): 95] [EEG (%BC): 95] [EMG (%BC): 95] [MEG (%BC): 95] [Neuropsychological Testing and Biofeedback (%BC): 95] [Sleep Studies (%BC): 95] [Chemotherapy (%BC): 95] [Gamma Knife (%BC): 95] [Nuclear Medicine (%BC): 95] [Oncology (%BC): 95] [Radiation Therapy  (%BC): 95] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 95] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 95] [Occupational Therapy (%BC): 95] [Physical Therapy (%BC): 95] [Respiratory Services/Therapy  (%BC): 95] [Speech Therapy (%BC): 95] [Mental Health (%BC): 95] [OP ECT Mental Health (%BC): 95] [OP High Cost Drugs (%BC): 95] [Other Outpatient Implant (%BC): 95] [Hyperbarics (%BC): 95] [IV Therapy (%BC): 95] [Pulmonary Function (%BC): 95] [Pulmonary Rehabilitation (%BC): 95] [Trauma (%BC): 95] [All Other OP (%BC): 95]","count":"1 through 10","median_amount":87.6,"10th_percentile":50.0,"90th_percentile":263.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs Mt","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 100] [Observation (%BC): 100] [Emergency Department (%BC): 100] [Cardiac Rehabilitation Therapy (%BC): 100] [Cardiac Stress Test (%BC): 100] [Cardiology (%BC): 100] [Echocardiology (%BC): 100] [EKG/ECG  (%BC): 100] [Electrophysiology (%BC): 100] [Electrophysiologic Ablation (%BC): 100] [Electrophysiology and Mapping Studies (%BC): 100] [Holter Monitor/Telemetry (%BC): 100] [Other Cardiac Testing (%BC): 100] [Peripheral Vascular Lab (%BC): 100] [EEG (%BC): 100] [EMG (%BC): 100] [MEG (%BC): 100] [Neuropsychological Testing and Biofeedback (%BC): 100] [Sleep Studies (%BC): 100] [Chemotherapy (%BC): 100] [Gamma Knife (%BC): 100] [Nuclear Medicine (%BC): 100] [Oncology (%BC): 100] [Radiation Therapy  (%BC): 100] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 100] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 100] [Occupational Therapy (%BC): 100] [Physical Therapy (%BC): 100] [Respiratory Services/Therapy  (%BC): 100] [Speech Therapy (%BC): 100] [Mental Health (%BC): 100] [OP ECT Mental Health (%BC): 100] [OP High Cost Drugs (%BC): 100] [Other Outpatient Implant (%BC): 100] [Hyperbarics (%BC): 100] [IV Therapy (%BC): 100] [Pulmonary Function (%BC): 100] [Pulmonary Rehabilitation (%BC): 100] [Trauma (%BC): 100] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health Network","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1106","median_amount":244.01,"10th_percentile":234.21,"90th_percentile":244.01,"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":"Peak 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":211.8,"10th_percentile":204.74,"90th_percentile":215.33,"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":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":376.85,"10th_percentile":376.85,"90th_percentile":376.85},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":75.0,"10th_percentile":75.0,"90th_percentile":75.0}]}]},{"description":"Level 1 Type A ED Visits","code_information":[{"code":"5021","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"1 through 10","median_amount":311.06,"10th_percentile":311.06,"90th_percentile":311.06},{"payer_name":"Allegiance","plan_name":"Mmia","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Focus","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Options","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 95] [Observation (%BC): 95] [Emergency Department (%BC): 95] [Cardiac Rehabilitation Therapy (%BC): 95] [Cardiac Stress Test (%BC): 95] [Cardiology (%BC): 95] [Echocardiology (%BC): 95] [EKG/ECG  (%BC): 95] [Electrophysiology (%BC): 95] [Electrophysiologic Ablation (%BC): 95] [Electrophysiology and Mapping Studies (%BC): 95] [Holter Monitor/Telemetry (%BC): 95] [Other Cardiac Testing (%BC): 95] [Peripheral Vascular Lab (%BC): 95] [EEG (%BC): 95] [EMG (%BC): 95] [MEG (%BC): 95] [Neuropsychological Testing and Biofeedback (%BC): 95] [Sleep Studies (%BC): 95] [Chemotherapy (%BC): 95] [Gamma Knife (%BC): 95] [Nuclear Medicine (%BC): 95] [Oncology (%BC): 95] [Radiation Therapy  (%BC): 95] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 95] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 95] [Occupational Therapy (%BC): 95] [Physical Therapy (%BC): 95] [Respiratory Services/Therapy  (%BC): 95] [Speech Therapy (%BC): 95] [Mental Health (%BC): 95] [OP ECT Mental Health (%BC): 95] [OP High Cost Drugs (%BC): 95] [Other Outpatient Implant (%BC): 95] [Hyperbarics (%BC): 95] [IV Therapy (%BC): 95] [Pulmonary Function (%BC): 95] [Pulmonary Rehabilitation (%BC): 95] [Trauma (%BC): 95] [All Other OP (%BC): 95]","count":"1 through 10","median_amount":233.67,"10th_percentile":179.55,"90th_percentile":233.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs Mt","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 100] [Observation (%BC): 100] [Emergency Department (%BC): 100] [Cardiac Rehabilitation Therapy (%BC): 100] [Cardiac Stress Test (%BC): 100] [Cardiology (%BC): 100] [Echocardiology (%BC): 100] [EKG/ECG  (%BC): 100] [Electrophysiology (%BC): 100] [Electrophysiologic Ablation (%BC): 100] [Electrophysiology and Mapping Studies (%BC): 100] [Holter Monitor/Telemetry (%BC): 100] [Other Cardiac Testing (%BC): 100] [Peripheral Vascular Lab (%BC): 100] [EEG (%BC): 100] [EMG (%BC): 100] [MEG (%BC): 100] [Neuropsychological Testing and Biofeedback (%BC): 100] [Sleep Studies (%BC): 100] [Chemotherapy (%BC): 100] [Gamma Knife (%BC): 100] [Nuclear Medicine (%BC): 100] [Oncology (%BC): 100] [Radiation Therapy  (%BC): 100] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 100] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 100] [Occupational Therapy (%BC): 100] [Physical Therapy (%BC): 100] [Respiratory Services/Therapy  (%BC): 100] [Speech Therapy (%BC): 100] [Mental Health (%BC): 100] [OP ECT Mental Health (%BC): 100] [OP High Cost Drugs (%BC): 100] [Other Outpatient Implant (%BC): 100] [Hyperbarics (%BC): 100] [IV Therapy (%BC): 100] [Pulmonary Function (%BC): 100] [Pulmonary Rehabilitation (%BC): 100] [Trauma (%BC): 100] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health Network","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":140.29,"10th_percentile":54.05,"90th_percentile":205.66,"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":"Mountain Health Co-Op","plan_name":"Peak 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Type A ED Visits","code_information":[{"code":"5022","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"1 through 10","median_amount":334.16,"10th_percentile":119.13,"90th_percentile":632.44},{"payer_name":"Allegiance","plan_name":"Mmia","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"1 through 10","median_amount":329.13,"10th_percentile":329.13,"90th_percentile":329.13},{"payer_name":"Bcbs Mt","plan_name":"Blue Focus","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":346.93,"10th_percentile":312.55,"90th_percentile":450.05},{"payer_name":"Bcbs Mt","plan_name":"Blue Options","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":223.72,"10th_percentile":223.72,"90th_percentile":223.72,"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 Mt","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 95] [Observation (%BC): 95] [Emergency Department (%BC): 95] [Cardiac Rehabilitation Therapy (%BC): 95] [Cardiac Stress Test (%BC): 95] [Cardiology (%BC): 95] [Echocardiology (%BC): 95] [EKG/ECG  (%BC): 95] [Electrophysiology (%BC): 95] [Electrophysiologic Ablation (%BC): 95] [Electrophysiology and Mapping Studies (%BC): 95] [Holter Monitor/Telemetry (%BC): 95] [Other Cardiac Testing (%BC): 95] [Peripheral Vascular Lab (%BC): 95] [EEG (%BC): 95] [EMG (%BC): 95] [MEG (%BC): 95] [Neuropsychological Testing and Biofeedback (%BC): 95] [Sleep Studies (%BC): 95] [Chemotherapy (%BC): 95] [Gamma Knife (%BC): 95] [Nuclear Medicine (%BC): 95] [Oncology (%BC): 95] [Radiation Therapy  (%BC): 95] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 95] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 95] [Occupational Therapy (%BC): 95] [Physical Therapy (%BC): 95] [Respiratory Services/Therapy  (%BC): 95] [Speech Therapy (%BC): 95] [Mental Health (%BC): 95] [OP ECT Mental Health (%BC): 95] [OP High Cost Drugs (%BC): 95] [Other Outpatient Implant (%BC): 95] [Hyperbarics (%BC): 95] [IV Therapy (%BC): 95] [Pulmonary Function (%BC): 95] [Pulmonary Rehabilitation (%BC): 95] [Trauma (%BC): 95] [All Other OP (%BC): 95]","count":"36","median_amount":389.82,"10th_percentile":224.75,"90th_percentile":648.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs Mt","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 100] [Observation (%BC): 100] [Emergency Department (%BC): 100] [Cardiac Rehabilitation Therapy (%BC): 100] [Cardiac Stress Test (%BC): 100] [Cardiology (%BC): 100] [Echocardiology (%BC): 100] [EKG/ECG  (%BC): 100] [Electrophysiology (%BC): 100] [Electrophysiologic Ablation (%BC): 100] [Electrophysiology and Mapping Studies (%BC): 100] [Holter Monitor/Telemetry (%BC): 100] [Other Cardiac Testing (%BC): 100] [Peripheral Vascular Lab (%BC): 100] [EEG (%BC): 100] [EMG (%BC): 100] [MEG (%BC): 100] [Neuropsychological Testing and Biofeedback (%BC): 100] [Sleep Studies (%BC): 100] [Chemotherapy (%BC): 100] [Gamma Knife (%BC): 100] [Nuclear Medicine (%BC): 100] [Oncology (%BC): 100] [Radiation Therapy  (%BC): 100] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 100] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 100] [Occupational Therapy (%BC): 100] [Physical Therapy (%BC): 100] [Respiratory Services/Therapy  (%BC): 100] [Speech Therapy (%BC): 100] [Mental Health (%BC): 100] [OP ECT Mental Health (%BC): 100] [OP High Cost Drugs (%BC): 100] [Other Outpatient Implant (%BC): 100] [Hyperbarics (%BC): 100] [IV Therapy (%BC): 100] [Pulmonary Function (%BC): 100] [Pulmonary Rehabilitation (%BC): 100] [Trauma (%BC): 100] [All Other OP (%BC): 100]","count":"1 through 10","median_amount":439.94,"10th_percentile":439.94,"90th_percentile":564.0,"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 Network","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"1 through 10","median_amount":319.13,"10th_percentile":319.13,"90th_percentile":319.13},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"23","median_amount":336.04,"10th_percentile":177.44,"90th_percentile":655.74,"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":"Mountain Health Co-Op","plan_name":"Peak 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":332.79,"10th_percentile":250.04,"90th_percentile":578.68}]}]},{"description":"Level 3 Type A ED Visits","code_information":[{"code":"5023","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"1 through 10","median_amount":928.34,"10th_percentile":596.38,"90th_percentile":5653.0},{"payer_name":"Allegiance","plan_name":"Mmia","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":495.16,"10th_percentile":495.16,"90th_percentile":495.16,"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":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":30.0,"10th_percentile":30.0,"90th_percentile":30.0},{"payer_name":"Bcbs Mt","plan_name":"Blue Focus","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"17","median_amount":1007.5,"10th_percentile":417.53,"90th_percentile":2662.82},{"payer_name":"Bcbs Mt","plan_name":"Blue Options","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":669.19,"10th_percentile":669.19,"90th_percentile":669.19,"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":"Bcbs Mt","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 95] [Observation (%BC): 95] [Emergency Department (%BC): 95] [Cardiac Rehabilitation Therapy (%BC): 95] [Cardiac Stress Test (%BC): 95] [Cardiology (%BC): 95] [Echocardiology (%BC): 95] [EKG/ECG  (%BC): 95] [Electrophysiology (%BC): 95] [Electrophysiologic Ablation (%BC): 95] [Electrophysiology and Mapping Studies (%BC): 95] [Holter Monitor/Telemetry (%BC): 95] [Other Cardiac Testing (%BC): 95] [Peripheral Vascular Lab (%BC): 95] [EEG (%BC): 95] [EMG (%BC): 95] [MEG (%BC): 95] [Neuropsychological Testing and Biofeedback (%BC): 95] [Sleep Studies (%BC): 95] [Chemotherapy (%BC): 95] [Gamma Knife (%BC): 95] [Nuclear Medicine (%BC): 95] [Oncology (%BC): 95] [Radiation Therapy  (%BC): 95] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 95] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 95] [Occupational Therapy (%BC): 95] [Physical Therapy (%BC): 95] [Respiratory Services/Therapy  (%BC): 95] [Speech Therapy (%BC): 95] [Mental Health (%BC): 95] [OP ECT Mental Health (%BC): 95] [OP High Cost Drugs (%BC): 95] [Other Outpatient Implant (%BC): 95] [Hyperbarics (%BC): 95] [IV Therapy (%BC): 95] [Pulmonary Function (%BC): 95] [Pulmonary Rehabilitation (%BC): 95] [Trauma (%BC): 95] [All Other OP (%BC): 95]","count":"69","median_amount":856.9,"10th_percentile":429.0,"90th_percentile":1908.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs Mt","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 100] [Observation (%BC): 100] [Emergency Department (%BC): 100] [Cardiac Rehabilitation Therapy (%BC): 100] [Cardiac Stress Test (%BC): 100] [Cardiology (%BC): 100] [Echocardiology (%BC): 100] [EKG/ECG  (%BC): 100] [Electrophysiology (%BC): 100] [Electrophysiologic Ablation (%BC): 100] [Electrophysiology and Mapping Studies (%BC): 100] [Holter Monitor/Telemetry (%BC): 100] [Other Cardiac Testing (%BC): 100] [Peripheral Vascular Lab (%BC): 100] [EEG (%BC): 100] [EMG (%BC): 100] [MEG (%BC): 100] [Neuropsychological Testing and Biofeedback (%BC): 100] [Sleep Studies (%BC): 100] [Chemotherapy (%BC): 100] [Gamma Knife (%BC): 100] [Nuclear Medicine (%BC): 100] [Oncology (%BC): 100] [Radiation Therapy  (%BC): 100] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 100] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 100] [Occupational Therapy (%BC): 100] [Physical Therapy (%BC): 100] [Respiratory Services/Therapy  (%BC): 100] [Speech Therapy (%BC): 100] [Mental Health (%BC): 100] [OP ECT Mental Health (%BC): 100] [OP High Cost Drugs (%BC): 100] [Other Outpatient Implant (%BC): 100] [Hyperbarics (%BC): 100] [IV Therapy (%BC): 100] [Pulmonary Function (%BC): 100] [Pulmonary Rehabilitation (%BC): 100] [Trauma (%BC): 100] [All Other OP (%BC): 100]","count":"1 through 10","median_amount":916.81,"10th_percentile":623.0,"90th_percentile":2531.0,"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 Network","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"63","median_amount":878.71,"10th_percentile":517.96,"90th_percentile":2812.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_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":"Peak 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"1 through 10","median_amount":874.48,"10th_percentile":459.75,"90th_percentile":1819.62},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"14","median_amount":1099.73,"10th_percentile":715.83,"90th_percentile":1673.1}]}]},{"description":"Level 4 Type A ED Visits","code_information":[{"code":"5024","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"1 through 10","median_amount":3199.06,"10th_percentile":2324.98,"90th_percentile":5509.48},{"payer_name":"Allegiance","plan_name":"Mmia","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"1 through 10","median_amount":2215.26,"10th_percentile":2215.26,"90th_percentile":2215.26},{"payer_name":"Bcbs Mt","plan_name":"Blue Focus","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"14","median_amount":4076.45,"10th_percentile":1053.79,"90th_percentile":6752.94},{"payer_name":"Bcbs Mt","plan_name":"Blue Options","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":4891.98,"10th_percentile":2094.58,"90th_percentile":8032.91,"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 Mt","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 95] [Observation (%BC): 95] [Emergency Department (%BC): 95] [Cardiac Rehabilitation Therapy (%BC): 95] [Cardiac Stress Test (%BC): 95] [Cardiology (%BC): 95] [Echocardiology (%BC): 95] [EKG/ECG  (%BC): 95] [Electrophysiology (%BC): 95] [Electrophysiologic Ablation (%BC): 95] [Electrophysiology and Mapping Studies (%BC): 95] [Holter Monitor/Telemetry (%BC): 95] [Other Cardiac Testing (%BC): 95] [Peripheral Vascular Lab (%BC): 95] [EEG (%BC): 95] [EMG (%BC): 95] [MEG (%BC): 95] [Neuropsychological Testing and Biofeedback (%BC): 95] [Sleep Studies (%BC): 95] [Chemotherapy (%BC): 95] [Gamma Knife (%BC): 95] [Nuclear Medicine (%BC): 95] [Oncology (%BC): 95] [Radiation Therapy  (%BC): 95] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 95] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 95] [Occupational Therapy (%BC): 95] [Physical Therapy (%BC): 95] [Respiratory Services/Therapy  (%BC): 95] [Speech Therapy (%BC): 95] [Mental Health (%BC): 95] [OP ECT Mental Health (%BC): 95] [OP High Cost Drugs (%BC): 95] [Other Outpatient Implant (%BC): 95] [Hyperbarics (%BC): 95] [IV Therapy (%BC): 95] [Pulmonary Function (%BC): 95] [Pulmonary Rehabilitation (%BC): 95] [Trauma (%BC): 95] [All Other OP (%BC): 95]","count":"45","median_amount":2484.54,"10th_percentile":1421.15,"90th_percentile":5624.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs Mt","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 100] [Observation (%BC): 100] [Emergency Department (%BC): 100] [Cardiac Rehabilitation Therapy (%BC): 100] [Cardiac Stress Test (%BC): 100] [Cardiology (%BC): 100] [Echocardiology (%BC): 100] [EKG/ECG  (%BC): 100] [Electrophysiology (%BC): 100] [Electrophysiologic Ablation (%BC): 100] [Electrophysiology and Mapping Studies (%BC): 100] [Holter Monitor/Telemetry (%BC): 100] [Other Cardiac Testing (%BC): 100] [Peripheral Vascular Lab (%BC): 100] [EEG (%BC): 100] [EMG (%BC): 100] [MEG (%BC): 100] [Neuropsychological Testing and Biofeedback (%BC): 100] [Sleep Studies (%BC): 100] [Chemotherapy (%BC): 100] [Gamma Knife (%BC): 100] [Nuclear Medicine (%BC): 100] [Oncology (%BC): 100] [Radiation Therapy  (%BC): 100] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 100] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 100] [Occupational Therapy (%BC): 100] [Physical Therapy (%BC): 100] [Respiratory Services/Therapy  (%BC): 100] [Speech Therapy (%BC): 100] [Mental Health (%BC): 100] [OP ECT Mental Health (%BC): 100] [OP High Cost Drugs (%BC): 100] [Other Outpatient Implant (%BC): 100] [Hyperbarics (%BC): 100] [IV Therapy (%BC): 100] [Pulmonary Function (%BC): 100] [Pulmonary Rehabilitation (%BC): 100] [Trauma (%BC): 100] [All Other OP (%BC): 100]","count":"1 through 10","median_amount":3185.0,"10th_percentile":3185.0,"90th_percentile":5572.23,"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":"First Choice Health Network","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"1 through 10","median_amount":8385.24,"10th_percentile":8385.24,"90th_percentile":8385.24},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"87","median_amount":2666.82,"10th_percentile":987.54,"90th_percentile":7062.36,"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":"Peak Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":2786.37,"10th_percentile":2786.37,"90th_percentile":2786.37},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"1 through 10","median_amount":4298.1,"10th_percentile":4298.1,"90th_percentile":4298.1},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"16","median_amount":2609.65,"10th_percentile":1173.5,"90th_percentile":7752.0}]}]},{"description":"Level 5 Type A ED Visits","code_information":[{"code":"5025","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"1 through 10","median_amount":13220.13,"10th_percentile":13220.13,"90th_percentile":13220.13},{"payer_name":"Allegiance","plan_name":"Mmia","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Focus","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":18321.94,"10th_percentile":18321.94,"90th_percentile":18321.94},{"payer_name":"Bcbs Mt","plan_name":"Blue Options","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":458.17,"10th_percentile":458.17,"90th_percentile":458.17,"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":"Bcbs Mt","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 95] [Observation (%BC): 95] [Emergency Department (%BC): 95] [Cardiac Rehabilitation Therapy (%BC): 95] [Cardiac Stress Test (%BC): 95] [Cardiology (%BC): 95] [Echocardiology (%BC): 95] [EKG/ECG  (%BC): 95] [Electrophysiology (%BC): 95] [Electrophysiologic Ablation (%BC): 95] [Electrophysiology and Mapping Studies (%BC): 95] [Holter Monitor/Telemetry (%BC): 95] [Other Cardiac Testing (%BC): 95] [Peripheral Vascular Lab (%BC): 95] [EEG (%BC): 95] [EMG (%BC): 95] [MEG (%BC): 95] [Neuropsychological Testing and Biofeedback (%BC): 95] [Sleep Studies (%BC): 95] [Chemotherapy (%BC): 95] [Gamma Knife (%BC): 95] [Nuclear Medicine (%BC): 95] [Oncology (%BC): 95] [Radiation Therapy  (%BC): 95] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 95] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 95] [Occupational Therapy (%BC): 95] [Physical Therapy (%BC): 95] [Respiratory Services/Therapy  (%BC): 95] [Speech Therapy (%BC): 95] [Mental Health (%BC): 95] [OP ECT Mental Health (%BC): 95] [OP High Cost Drugs (%BC): 95] [Other Outpatient Implant (%BC): 95] [Hyperbarics (%BC): 95] [IV Therapy (%BC): 95] [Pulmonary Function (%BC): 95] [Pulmonary Rehabilitation (%BC): 95] [Trauma (%BC): 95] [All Other OP (%BC): 95]","count":"12","median_amount":5821.6,"10th_percentile":2525.19,"90th_percentile":11520.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs Mt","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 100] [Observation (%BC): 100] [Emergency Department (%BC): 100] [Cardiac Rehabilitation Therapy (%BC): 100] [Cardiac Stress Test (%BC): 100] [Cardiology (%BC): 100] [Echocardiology (%BC): 100] [EKG/ECG  (%BC): 100] [Electrophysiology (%BC): 100] [Electrophysiologic Ablation (%BC): 100] [Electrophysiology and Mapping Studies (%BC): 100] [Holter Monitor/Telemetry (%BC): 100] [Other Cardiac Testing (%BC): 100] [Peripheral Vascular Lab (%BC): 100] [EEG (%BC): 100] [EMG (%BC): 100] [MEG (%BC): 100] [Neuropsychological Testing and Biofeedback (%BC): 100] [Sleep Studies (%BC): 100] [Chemotherapy (%BC): 100] [Gamma Knife (%BC): 100] [Nuclear Medicine (%BC): 100] [Oncology (%BC): 100] [Radiation Therapy  (%BC): 100] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 100] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 100] [Occupational Therapy (%BC): 100] [Physical Therapy (%BC): 100] [Respiratory Services/Therapy  (%BC): 100] [Speech Therapy (%BC): 100] [Mental Health (%BC): 100] [OP ECT Mental Health (%BC): 100] [OP High Cost Drugs (%BC): 100] [Other Outpatient Implant (%BC): 100] [Hyperbarics (%BC): 100] [IV Therapy (%BC): 100] [Pulmonary Function (%BC): 100] [Pulmonary Rehabilitation (%BC): 100] [Trauma (%BC): 100] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health Network","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"15","median_amount":3770.65,"10th_percentile":170.92,"90th_percentile":10322.21,"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":"Peak 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"1 through 10","median_amount":2547.9,"10th_percentile":2547.9,"90th_percentile":2547.9},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":1141.5,"10th_percentile":1141.5,"90th_percentile":1141.5}]}]},{"description":"Critical Care","code_information":[{"code":"5041","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Focus","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Options","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 95] [Observation (%BC): 95] [Emergency Department (%BC): 95] [Cardiac Rehabilitation Therapy (%BC): 95] [Cardiac Stress Test (%BC): 95] [Cardiology (%BC): 95] [Echocardiology (%BC): 95] [EKG/ECG  (%BC): 95] [Electrophysiology (%BC): 95] [Electrophysiologic Ablation (%BC): 95] [Electrophysiology and Mapping Studies (%BC): 95] [Holter Monitor/Telemetry (%BC): 95] [Other Cardiac Testing (%BC): 95] [Peripheral Vascular Lab (%BC): 95] [EEG (%BC): 95] [EMG (%BC): 95] [MEG (%BC): 95] [Neuropsychological Testing and Biofeedback (%BC): 95] [Sleep Studies (%BC): 95] [Chemotherapy (%BC): 95] [Gamma Knife (%BC): 95] [Nuclear Medicine (%BC): 95] [Oncology (%BC): 95] [Radiation Therapy  (%BC): 95] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 95] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 95] [Occupational Therapy (%BC): 95] [Physical Therapy (%BC): 95] [Respiratory Services/Therapy  (%BC): 95] [Speech Therapy (%BC): 95] [Mental Health (%BC): 95] [OP ECT Mental Health (%BC): 95] [OP High Cost Drugs (%BC): 95] [Other Outpatient Implant (%BC): 95] [Hyperbarics (%BC): 95] [IV Therapy (%BC): 95] [Pulmonary Function (%BC): 95] [Pulmonary Rehabilitation (%BC): 95] [Trauma (%BC): 95] [All Other OP (%BC): 95]","count":"1 through 10","median_amount":16817.45,"10th_percentile":16817.45,"90th_percentile":16817.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs Mt","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 100] [Observation (%BC): 100] [Emergency Department (%BC): 100] [Cardiac Rehabilitation Therapy (%BC): 100] [Cardiac Stress Test (%BC): 100] [Cardiology (%BC): 100] [Echocardiology (%BC): 100] [EKG/ECG  (%BC): 100] [Electrophysiology (%BC): 100] [Electrophysiologic Ablation (%BC): 100] [Electrophysiology and Mapping Studies (%BC): 100] [Holter Monitor/Telemetry (%BC): 100] [Other Cardiac Testing (%BC): 100] [Peripheral Vascular Lab (%BC): 100] [EEG (%BC): 100] [EMG (%BC): 100] [MEG (%BC): 100] [Neuropsychological Testing and Biofeedback (%BC): 100] [Sleep Studies (%BC): 100] [Chemotherapy (%BC): 100] [Gamma Knife (%BC): 100] [Nuclear Medicine (%BC): 100] [Oncology (%BC): 100] [Radiation Therapy  (%BC): 100] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 100] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 100] [Occupational Therapy (%BC): 100] [Physical Therapy (%BC): 100] [Respiratory Services/Therapy  (%BC): 100] [Speech Therapy (%BC): 100] [Mental Health (%BC): 100] [OP ECT Mental Health (%BC): 100] [OP High Cost Drugs (%BC): 100] [Other Outpatient Implant (%BC): 100] [Hyperbarics (%BC): 100] [IV Therapy (%BC): 100] [Pulmonary Function (%BC): 100] [Pulmonary Rehabilitation (%BC): 100] [Trauma (%BC): 100] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health Network","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":304.64,"10th_percentile":240.96,"90th_percentile":15700.07,"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":"Peak 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Skin Procedures","code_information":[{"code":"5051","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Focus","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Options","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":279.2,"10th_percentile":279.2,"90th_percentile":344.8,"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":"Bcbs Mt","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 95] [Observation (%BC): 95] [Emergency Department (%BC): 95] [Cardiac Rehabilitation Therapy (%BC): 95] [Cardiac Stress Test (%BC): 95] [Cardiology (%BC): 95] [Echocardiology (%BC): 95] [EKG/ECG  (%BC): 95] [Electrophysiology (%BC): 95] [Electrophysiologic Ablation (%BC): 95] [Electrophysiology and Mapping Studies (%BC): 95] [Holter Monitor/Telemetry (%BC): 95] [Other Cardiac Testing (%BC): 95] [Peripheral Vascular Lab (%BC): 95] [EEG (%BC): 95] [EMG (%BC): 95] [MEG (%BC): 95] [Neuropsychological Testing and Biofeedback (%BC): 95] [Sleep Studies (%BC): 95] [Chemotherapy (%BC): 95] [Gamma Knife (%BC): 95] [Nuclear Medicine (%BC): 95] [Oncology (%BC): 95] [Radiation Therapy  (%BC): 95] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 95] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 95] [Occupational Therapy (%BC): 95] [Physical Therapy (%BC): 95] [Respiratory Services/Therapy  (%BC): 95] [Speech Therapy (%BC): 95] [Mental Health (%BC): 95] [OP ECT Mental Health (%BC): 95] [OP High Cost Drugs (%BC): 95] [Other Outpatient Implant (%BC): 95] [Hyperbarics (%BC): 95] [IV Therapy (%BC): 95] [Pulmonary Function (%BC): 95] [Pulmonary Rehabilitation (%BC): 95] [Trauma (%BC): 95] [All Other OP (%BC): 95]","count":"1 through 10","median_amount":1018.4,"10th_percentile":1018.4,"90th_percentile":1018.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs Mt","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 100] [Observation (%BC): 100] [Emergency Department (%BC): 100] [Cardiac Rehabilitation Therapy (%BC): 100] [Cardiac Stress Test (%BC): 100] [Cardiology (%BC): 100] [Echocardiology (%BC): 100] [EKG/ECG  (%BC): 100] [Electrophysiology (%BC): 100] [Electrophysiologic Ablation (%BC): 100] [Electrophysiology and Mapping Studies (%BC): 100] [Holter Monitor/Telemetry (%BC): 100] [Other Cardiac Testing (%BC): 100] [Peripheral Vascular Lab (%BC): 100] [EEG (%BC): 100] [EMG (%BC): 100] [MEG (%BC): 100] [Neuropsychological Testing and Biofeedback (%BC): 100] [Sleep Studies (%BC): 100] [Chemotherapy (%BC): 100] [Gamma Knife (%BC): 100] [Nuclear Medicine (%BC): 100] [Oncology (%BC): 100] [Radiation Therapy  (%BC): 100] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 100] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 100] [Occupational Therapy (%BC): 100] [Physical Therapy (%BC): 100] [Respiratory Services/Therapy  (%BC): 100] [Speech Therapy (%BC): 100] [Mental Health (%BC): 100] [OP ECT Mental Health (%BC): 100] [OP High Cost Drugs (%BC): 100] [Other Outpatient Implant (%BC): 100] [Hyperbarics (%BC): 100] [IV Therapy (%BC): 100] [Pulmonary Function (%BC): 100] [Pulmonary Rehabilitation (%BC): 100] [Trauma (%BC): 100] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health Network","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"25","median_amount":244.01,"10th_percentile":193.75,"90th_percentile":589.92,"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":"Mountain Health Co-Op","plan_name":"Peak 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"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":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Focus","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Options","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":637.84,"10th_percentile":637.84,"90th_percentile":637.84,"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 Mt","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 95] [Observation (%BC): 95] [Emergency Department (%BC): 95] [Cardiac Rehabilitation Therapy (%BC): 95] [Cardiac Stress Test (%BC): 95] [Cardiology (%BC): 95] [Echocardiology (%BC): 95] [EKG/ECG  (%BC): 95] [Electrophysiology (%BC): 95] [Electrophysiologic Ablation (%BC): 95] [Electrophysiology and Mapping Studies (%BC): 95] [Holter Monitor/Telemetry (%BC): 95] [Other Cardiac Testing (%BC): 95] [Peripheral Vascular Lab (%BC): 95] [EEG (%BC): 95] [EMG (%BC): 95] [MEG (%BC): 95] [Neuropsychological Testing and Biofeedback (%BC): 95] [Sleep Studies (%BC): 95] [Chemotherapy (%BC): 95] [Gamma Knife (%BC): 95] [Nuclear Medicine (%BC): 95] [Oncology (%BC): 95] [Radiation Therapy  (%BC): 95] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 95] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 95] [Occupational Therapy (%BC): 95] [Physical Therapy (%BC): 95] [Respiratory Services/Therapy  (%BC): 95] [Speech Therapy (%BC): 95] [Mental Health (%BC): 95] [OP ECT Mental Health (%BC): 95] [OP High Cost Drugs (%BC): 95] [Other Outpatient Implant (%BC): 95] [Hyperbarics (%BC): 95] [IV Therapy (%BC): 95] [Pulmonary Function (%BC): 95] [Pulmonary Rehabilitation (%BC): 95] [Trauma (%BC): 95] [All Other OP (%BC): 95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 100] [Observation (%BC): 100] [Emergency Department (%BC): 100] [Cardiac Rehabilitation Therapy (%BC): 100] [Cardiac Stress Test (%BC): 100] [Cardiology (%BC): 100] [Echocardiology (%BC): 100] [EKG/ECG  (%BC): 100] [Electrophysiology (%BC): 100] [Electrophysiologic Ablation (%BC): 100] [Electrophysiology and Mapping Studies (%BC): 100] [Holter Monitor/Telemetry (%BC): 100] [Other Cardiac Testing (%BC): 100] [Peripheral Vascular Lab (%BC): 100] [EEG (%BC): 100] [EMG (%BC): 100] [MEG (%BC): 100] [Neuropsychological Testing and Biofeedback (%BC): 100] [Sleep Studies (%BC): 100] [Chemotherapy (%BC): 100] [Gamma Knife (%BC): 100] [Nuclear Medicine (%BC): 100] [Oncology (%BC): 100] [Radiation Therapy  (%BC): 100] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 100] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 100] [Occupational Therapy (%BC): 100] [Physical Therapy (%BC): 100] [Respiratory Services/Therapy  (%BC): 100] [Speech Therapy (%BC): 100] [Mental Health (%BC): 100] [OP ECT Mental Health (%BC): 100] [OP High Cost Drugs (%BC): 100] [Other Outpatient Implant (%BC): 100] [Hyperbarics (%BC): 100] [IV Therapy (%BC): 100] [Pulmonary Function (%BC): 100] [Pulmonary Rehabilitation (%BC): 100] [Trauma (%BC): 100] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health Network","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":59.34,"10th_percentile":59.34,"90th_percentile":59.34,"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":"Peak 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Focus","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Options","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":310.2,"10th_percentile":310.2,"90th_percentile":310.2,"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":"Bcbs Mt","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 95] [Observation (%BC): 95] [Emergency Department (%BC): 95] [Cardiac Rehabilitation Therapy (%BC): 95] [Cardiac Stress Test (%BC): 95] [Cardiology (%BC): 95] [Echocardiology (%BC): 95] [EKG/ECG  (%BC): 95] [Electrophysiology (%BC): 95] [Electrophysiologic Ablation (%BC): 95] [Electrophysiology and Mapping Studies (%BC): 95] [Holter Monitor/Telemetry (%BC): 95] [Other Cardiac Testing (%BC): 95] [Peripheral Vascular Lab (%BC): 95] [EEG (%BC): 95] [EMG (%BC): 95] [MEG (%BC): 95] [Neuropsychological Testing and Biofeedback (%BC): 95] [Sleep Studies (%BC): 95] [Chemotherapy (%BC): 95] [Gamma Knife (%BC): 95] [Nuclear Medicine (%BC): 95] [Oncology (%BC): 95] [Radiation Therapy  (%BC): 95] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 95] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 95] [Occupational Therapy (%BC): 95] [Physical Therapy (%BC): 95] [Respiratory Services/Therapy  (%BC): 95] [Speech Therapy (%BC): 95] [Mental Health (%BC): 95] [OP ECT Mental Health (%BC): 95] [OP High Cost Drugs (%BC): 95] [Other Outpatient Implant (%BC): 95] [Hyperbarics (%BC): 95] [IV Therapy (%BC): 95] [Pulmonary Function (%BC): 95] [Pulmonary Rehabilitation (%BC): 95] [Trauma (%BC): 95] [All Other OP (%BC): 95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 100] [Observation (%BC): 100] [Emergency Department (%BC): 100] [Cardiac Rehabilitation Therapy (%BC): 100] [Cardiac Stress Test (%BC): 100] [Cardiology (%BC): 100] [Echocardiology (%BC): 100] [EKG/ECG  (%BC): 100] [Electrophysiology (%BC): 100] [Electrophysiologic Ablation (%BC): 100] [Electrophysiology and Mapping Studies (%BC): 100] [Holter Monitor/Telemetry (%BC): 100] [Other Cardiac Testing (%BC): 100] [Peripheral Vascular Lab (%BC): 100] [EEG (%BC): 100] [EMG (%BC): 100] [MEG (%BC): 100] [Neuropsychological Testing and Biofeedback (%BC): 100] [Sleep Studies (%BC): 100] [Chemotherapy (%BC): 100] [Gamma Knife (%BC): 100] [Nuclear Medicine (%BC): 100] [Oncology (%BC): 100] [Radiation Therapy  (%BC): 100] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 100] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 100] [Occupational Therapy (%BC): 100] [Physical Therapy (%BC): 100] [Respiratory Services/Therapy  (%BC): 100] [Speech Therapy (%BC): 100] [Mental Health (%BC): 100] [OP ECT Mental Health (%BC): 100] [OP High Cost Drugs (%BC): 100] [Other Outpatient Implant (%BC): 100] [Hyperbarics (%BC): 100] [IV Therapy (%BC): 100] [Pulmonary Function (%BC): 100] [Pulmonary Rehabilitation (%BC): 100] [Trauma (%BC): 100] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health Network","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":244.01,"10th_percentile":244.01,"90th_percentile":244.01,"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":"Peak 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"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":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Focus","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":572.2,"10th_percentile":572.2,"90th_percentile":572.2},{"payer_name":"Bcbs Mt","plan_name":"Blue Options","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 95] [Observation (%BC): 95] [Emergency Department (%BC): 95] [Cardiac Rehabilitation Therapy (%BC): 95] [Cardiac Stress Test (%BC): 95] [Cardiology (%BC): 95] [Echocardiology (%BC): 95] [EKG/ECG  (%BC): 95] [Electrophysiology (%BC): 95] [Electrophysiologic Ablation (%BC): 95] [Electrophysiology and Mapping Studies (%BC): 95] [Holter Monitor/Telemetry (%BC): 95] [Other Cardiac Testing (%BC): 95] [Peripheral Vascular Lab (%BC): 95] [EEG (%BC): 95] [EMG (%BC): 95] [MEG (%BC): 95] [Neuropsychological Testing and Biofeedback (%BC): 95] [Sleep Studies (%BC): 95] [Chemotherapy (%BC): 95] [Gamma Knife (%BC): 95] [Nuclear Medicine (%BC): 95] [Oncology (%BC): 95] [Radiation Therapy  (%BC): 95] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 95] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 95] [Occupational Therapy (%BC): 95] [Physical Therapy (%BC): 95] [Respiratory Services/Therapy  (%BC): 95] [Speech Therapy (%BC): 95] [Mental Health (%BC): 95] [OP ECT Mental Health (%BC): 95] [OP High Cost Drugs (%BC): 95] [Other Outpatient Implant (%BC): 95] [Hyperbarics (%BC): 95] [IV Therapy (%BC): 95] [Pulmonary Function (%BC): 95] [Pulmonary Rehabilitation (%BC): 95] [Trauma (%BC): 95] [All Other OP (%BC): 95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 100] [Observation (%BC): 100] [Emergency Department (%BC): 100] [Cardiac Rehabilitation Therapy (%BC): 100] [Cardiac Stress Test (%BC): 100] [Cardiology (%BC): 100] [Echocardiology (%BC): 100] [EKG/ECG  (%BC): 100] [Electrophysiology (%BC): 100] [Electrophysiologic Ablation (%BC): 100] [Electrophysiology and Mapping Studies (%BC): 100] [Holter Monitor/Telemetry (%BC): 100] [Other Cardiac Testing (%BC): 100] [Peripheral Vascular Lab (%BC): 100] [EEG (%BC): 100] [EMG (%BC): 100] [MEG (%BC): 100] [Neuropsychological Testing and Biofeedback (%BC): 100] [Sleep Studies (%BC): 100] [Chemotherapy (%BC): 100] [Gamma Knife (%BC): 100] [Nuclear Medicine (%BC): 100] [Oncology (%BC): 100] [Radiation Therapy  (%BC): 100] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 100] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 100] [Occupational Therapy (%BC): 100] [Physical Therapy (%BC): 100] [Respiratory Services/Therapy  (%BC): 100] [Speech Therapy (%BC): 100] [Mental Health (%BC): 100] [OP ECT Mental Health (%BC): 100] [OP High Cost Drugs (%BC): 100] [Other Outpatient Implant (%BC): 100] [Hyperbarics (%BC): 100] [IV Therapy (%BC): 100] [Pulmonary Function (%BC): 100] [Pulmonary Rehabilitation (%BC): 100] [Trauma (%BC): 100] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health Network","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"13","median_amount":1208.32,"10th_percentile":830.97,"90th_percentile":2058.66,"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":"Mountain Health Co-Op","plan_name":"Peak 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"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":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Focus","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Options","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 95] [Observation (%BC): 95] [Emergency Department (%BC): 95] [Cardiac Rehabilitation Therapy (%BC): 95] [Cardiac Stress Test (%BC): 95] [Cardiology (%BC): 95] [Echocardiology (%BC): 95] [EKG/ECG  (%BC): 95] [Electrophysiology (%BC): 95] [Electrophysiologic Ablation (%BC): 95] [Electrophysiology and Mapping Studies (%BC): 95] [Holter Monitor/Telemetry (%BC): 95] [Other Cardiac Testing (%BC): 95] [Peripheral Vascular Lab (%BC): 95] [EEG (%BC): 95] [EMG (%BC): 95] [MEG (%BC): 95] [Neuropsychological Testing and Biofeedback (%BC): 95] [Sleep Studies (%BC): 95] [Chemotherapy (%BC): 95] [Gamma Knife (%BC): 95] [Nuclear Medicine (%BC): 95] [Oncology (%BC): 95] [Radiation Therapy  (%BC): 95] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 95] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 95] [Occupational Therapy (%BC): 95] [Physical Therapy (%BC): 95] [Respiratory Services/Therapy  (%BC): 95] [Speech Therapy (%BC): 95] [Mental Health (%BC): 95] [OP ECT Mental Health (%BC): 95] [OP High Cost Drugs (%BC): 95] [Other Outpatient Implant (%BC): 95] [Hyperbarics (%BC): 95] [IV Therapy (%BC): 95] [Pulmonary Function (%BC): 95] [Pulmonary Rehabilitation (%BC): 95] [Trauma (%BC): 95] [All Other OP (%BC): 95]","count":"1 through 10","median_amount":3707.3,"10th_percentile":3707.3,"90th_percentile":3707.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs Mt","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 100] [Observation (%BC): 100] [Emergency Department (%BC): 100] [Cardiac Rehabilitation Therapy (%BC): 100] [Cardiac Stress Test (%BC): 100] [Cardiology (%BC): 100] [Echocardiology (%BC): 100] [EKG/ECG  (%BC): 100] [Electrophysiology (%BC): 100] [Electrophysiologic Ablation (%BC): 100] [Electrophysiology and Mapping Studies (%BC): 100] [Holter Monitor/Telemetry (%BC): 100] [Other Cardiac Testing (%BC): 100] [Peripheral Vascular Lab (%BC): 100] [EEG (%BC): 100] [EMG (%BC): 100] [MEG (%BC): 100] [Neuropsychological Testing and Biofeedback (%BC): 100] [Sleep Studies (%BC): 100] [Chemotherapy (%BC): 100] [Gamma Knife (%BC): 100] [Nuclear Medicine (%BC): 100] [Oncology (%BC): 100] [Radiation Therapy  (%BC): 100] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 100] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 100] [Occupational Therapy (%BC): 100] [Physical Therapy (%BC): 100] [Respiratory Services/Therapy  (%BC): 100] [Speech Therapy (%BC): 100] [Mental Health (%BC): 100] [OP ECT Mental Health (%BC): 100] [OP High Cost Drugs (%BC): 100] [Other Outpatient Implant (%BC): 100] [Hyperbarics (%BC): 100] [IV Therapy (%BC): 100] [Pulmonary Function (%BC): 100] [Pulmonary Rehabilitation (%BC): 100] [Trauma (%BC): 100] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health Network","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Peak 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":117.7,"10th_percentile":117.7,"90th_percentile":117.7}]}]},{"description":"Level 3 Vascular Procedures","code_information":[{"code":"5183","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Focus","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Options","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 95] [Observation (%BC): 95] [Emergency Department (%BC): 95] [Cardiac Rehabilitation Therapy (%BC): 95] [Cardiac Stress Test (%BC): 95] [Cardiology (%BC): 95] [Echocardiology (%BC): 95] [EKG/ECG  (%BC): 95] [Electrophysiology (%BC): 95] [Electrophysiologic Ablation (%BC): 95] [Electrophysiology and Mapping Studies (%BC): 95] [Holter Monitor/Telemetry (%BC): 95] [Other Cardiac Testing (%BC): 95] [Peripheral Vascular Lab (%BC): 95] [EEG (%BC): 95] [EMG (%BC): 95] [MEG (%BC): 95] [Neuropsychological Testing and Biofeedback (%BC): 95] [Sleep Studies (%BC): 95] [Chemotherapy (%BC): 95] [Gamma Knife (%BC): 95] [Nuclear Medicine (%BC): 95] [Oncology (%BC): 95] [Radiation Therapy  (%BC): 95] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 95] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 95] [Occupational Therapy (%BC): 95] [Physical Therapy (%BC): 95] [Respiratory Services/Therapy  (%BC): 95] [Speech Therapy (%BC): 95] [Mental Health (%BC): 95] [OP ECT Mental Health (%BC): 95] [OP High Cost Drugs (%BC): 95] [Other Outpatient Implant (%BC): 95] [Hyperbarics (%BC): 95] [IV Therapy (%BC): 95] [Pulmonary Function (%BC): 95] [Pulmonary Rehabilitation (%BC): 95] [Trauma (%BC): 95] [All Other OP (%BC): 95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 100] [Observation (%BC): 100] [Emergency Department (%BC): 100] [Cardiac Rehabilitation Therapy (%BC): 100] [Cardiac Stress Test (%BC): 100] [Cardiology (%BC): 100] [Echocardiology (%BC): 100] [EKG/ECG  (%BC): 100] [Electrophysiology (%BC): 100] [Electrophysiologic Ablation (%BC): 100] [Electrophysiology and Mapping Studies (%BC): 100] [Holter Monitor/Telemetry (%BC): 100] [Other Cardiac Testing (%BC): 100] [Peripheral Vascular Lab (%BC): 100] [EEG (%BC): 100] [EMG (%BC): 100] [MEG (%BC): 100] [Neuropsychological Testing and Biofeedback (%BC): 100] [Sleep Studies (%BC): 100] [Chemotherapy (%BC): 100] [Gamma Knife (%BC): 100] [Nuclear Medicine (%BC): 100] [Oncology (%BC): 100] [Radiation Therapy  (%BC): 100] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 100] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 100] [Occupational Therapy (%BC): 100] [Physical Therapy (%BC): 100] [Respiratory Services/Therapy  (%BC): 100] [Speech Therapy (%BC): 100] [Mental Health (%BC): 100] [OP ECT Mental Health (%BC): 100] [OP High Cost Drugs (%BC): 100] [Other Outpatient Implant (%BC): 100] [Hyperbarics (%BC): 100] [IV Therapy (%BC): 100] [Pulmonary Function (%BC): 100] [Pulmonary Rehabilitation (%BC): 100] [Trauma (%BC): 100] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health Network","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":656.91,"10th_percentile":656.91,"90th_percentile":656.91,"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":"Peak 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"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":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Focus","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Options","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 95] [Observation (%BC): 95] [Emergency Department (%BC): 95] [Cardiac Rehabilitation Therapy (%BC): 95] [Cardiac Stress Test (%BC): 95] [Cardiology (%BC): 95] [Echocardiology (%BC): 95] [EKG/ECG  (%BC): 95] [Electrophysiology (%BC): 95] [Electrophysiologic Ablation (%BC): 95] [Electrophysiology and Mapping Studies (%BC): 95] [Holter Monitor/Telemetry (%BC): 95] [Other Cardiac Testing (%BC): 95] [Peripheral Vascular Lab (%BC): 95] [EEG (%BC): 95] [EMG (%BC): 95] [MEG (%BC): 95] [Neuropsychological Testing and Biofeedback (%BC): 95] [Sleep Studies (%BC): 95] [Chemotherapy (%BC): 95] [Gamma Knife (%BC): 95] [Nuclear Medicine (%BC): 95] [Oncology (%BC): 95] [Radiation Therapy  (%BC): 95] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 95] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 95] [Occupational Therapy (%BC): 95] [Physical Therapy (%BC): 95] [Respiratory Services/Therapy  (%BC): 95] [Speech Therapy (%BC): 95] [Mental Health (%BC): 95] [OP ECT Mental Health (%BC): 95] [OP High Cost Drugs (%BC): 95] [Other Outpatient Implant (%BC): 95] [Hyperbarics (%BC): 95] [IV Therapy (%BC): 95] [Pulmonary Function (%BC): 95] [Pulmonary Rehabilitation (%BC): 95] [Trauma (%BC): 95] [All Other OP (%BC): 95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 100] [Observation (%BC): 100] [Emergency Department (%BC): 100] [Cardiac Rehabilitation Therapy (%BC): 100] [Cardiac Stress Test (%BC): 100] [Cardiology (%BC): 100] [Echocardiology (%BC): 100] [EKG/ECG  (%BC): 100] [Electrophysiology (%BC): 100] [Electrophysiologic Ablation (%BC): 100] [Electrophysiology and Mapping Studies (%BC): 100] [Holter Monitor/Telemetry (%BC): 100] [Other Cardiac Testing (%BC): 100] [Peripheral Vascular Lab (%BC): 100] [EEG (%BC): 100] [EMG (%BC): 100] [MEG (%BC): 100] [Neuropsychological Testing and Biofeedback (%BC): 100] [Sleep Studies (%BC): 100] [Chemotherapy (%BC): 100] [Gamma Knife (%BC): 100] [Nuclear Medicine (%BC): 100] [Oncology (%BC): 100] [Radiation Therapy  (%BC): 100] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 100] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 100] [Occupational Therapy (%BC): 100] [Physical Therapy (%BC): 100] [Respiratory Services/Therapy  (%BC): 100] [Speech Therapy (%BC): 100] [Mental Health (%BC): 100] [OP ECT Mental Health (%BC): 100] [OP High Cost Drugs (%BC): 100] [Other Outpatient Implant (%BC): 100] [Hyperbarics (%BC): 100] [IV Therapy (%BC): 100] [Pulmonary Function (%BC): 100] [Pulmonary Rehabilitation (%BC): 100] [Trauma (%BC): 100] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health Network","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":15399.16,"10th_percentile":15399.16,"90th_percentile":15399.16,"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":"Peak 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"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":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Focus","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Options","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 95] [Observation (%BC): 95] [Emergency Department (%BC): 95] [Cardiac Rehabilitation Therapy (%BC): 95] [Cardiac Stress Test (%BC): 95] [Cardiology (%BC): 95] [Echocardiology (%BC): 95] [EKG/ECG  (%BC): 95] [Electrophysiology (%BC): 95] [Electrophysiologic Ablation (%BC): 95] [Electrophysiology and Mapping Studies (%BC): 95] [Holter Monitor/Telemetry (%BC): 95] [Other Cardiac Testing (%BC): 95] [Peripheral Vascular Lab (%BC): 95] [EEG (%BC): 95] [EMG (%BC): 95] [MEG (%BC): 95] [Neuropsychological Testing and Biofeedback (%BC): 95] [Sleep Studies (%BC): 95] [Chemotherapy (%BC): 95] [Gamma Knife (%BC): 95] [Nuclear Medicine (%BC): 95] [Oncology (%BC): 95] [Radiation Therapy  (%BC): 95] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 95] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 95] [Occupational Therapy (%BC): 95] [Physical Therapy (%BC): 95] [Respiratory Services/Therapy  (%BC): 95] [Speech Therapy (%BC): 95] [Mental Health (%BC): 95] [OP ECT Mental Health (%BC): 95] [OP High Cost Drugs (%BC): 95] [Other Outpatient Implant (%BC): 95] [Hyperbarics (%BC): 95] [IV Therapy (%BC): 95] [Pulmonary Function (%BC): 95] [Pulmonary Rehabilitation (%BC): 95] [Trauma (%BC): 95] [All Other OP (%BC): 95]","count":"1 through 10","median_amount":1466.52,"10th_percentile":1308.19,"90th_percentile":2791.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs Mt","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 100] [Observation (%BC): 100] [Emergency Department (%BC): 100] [Cardiac Rehabilitation Therapy (%BC): 100] [Cardiac Stress Test (%BC): 100] [Cardiology (%BC): 100] [Echocardiology (%BC): 100] [EKG/ECG  (%BC): 100] [Electrophysiology (%BC): 100] [Electrophysiologic Ablation (%BC): 100] [Electrophysiology and Mapping Studies (%BC): 100] [Holter Monitor/Telemetry (%BC): 100] [Other Cardiac Testing (%BC): 100] [Peripheral Vascular Lab (%BC): 100] [EEG (%BC): 100] [EMG (%BC): 100] [MEG (%BC): 100] [Neuropsychological Testing and Biofeedback (%BC): 100] [Sleep Studies (%BC): 100] [Chemotherapy (%BC): 100] [Gamma Knife (%BC): 100] [Nuclear Medicine (%BC): 100] [Oncology (%BC): 100] [Radiation Therapy  (%BC): 100] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 100] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 100] [Occupational Therapy (%BC): 100] [Physical Therapy (%BC): 100] [Respiratory Services/Therapy  (%BC): 100] [Speech Therapy (%BC): 100] [Mental Health (%BC): 100] [OP ECT Mental Health (%BC): 100] [OP High Cost Drugs (%BC): 100] [Other Outpatient Implant (%BC): 100] [Hyperbarics (%BC): 100] [IV Therapy (%BC): 100] [Pulmonary Function (%BC): 100] [Pulmonary Rehabilitation (%BC): 100] [Trauma (%BC): 100] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health Network","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":606.84,"10th_percentile":606.84,"90th_percentile":1005.12,"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":"Peak 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"1 through 10","median_amount":2352.2,"10th_percentile":2352.2,"90th_percentile":2352.2},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Upper GI Procedures","code_information":[{"code":"5302","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Focus","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Options","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 95] [Observation (%BC): 95] [Emergency Department (%BC): 95] [Cardiac Rehabilitation Therapy (%BC): 95] [Cardiac Stress Test (%BC): 95] [Cardiology (%BC): 95] [Echocardiology (%BC): 95] [EKG/ECG  (%BC): 95] [Electrophysiology (%BC): 95] [Electrophysiologic Ablation (%BC): 95] [Electrophysiology and Mapping Studies (%BC): 95] [Holter Monitor/Telemetry (%BC): 95] [Other Cardiac Testing (%BC): 95] [Peripheral Vascular Lab (%BC): 95] [EEG (%BC): 95] [EMG (%BC): 95] [MEG (%BC): 95] [Neuropsychological Testing and Biofeedback (%BC): 95] [Sleep Studies (%BC): 95] [Chemotherapy (%BC): 95] [Gamma Knife (%BC): 95] [Nuclear Medicine (%BC): 95] [Oncology (%BC): 95] [Radiation Therapy  (%BC): 95] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 95] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 95] [Occupational Therapy (%BC): 95] [Physical Therapy (%BC): 95] [Respiratory Services/Therapy  (%BC): 95] [Speech Therapy (%BC): 95] [Mental Health (%BC): 95] [OP ECT Mental Health (%BC): 95] [OP High Cost Drugs (%BC): 95] [Other Outpatient Implant (%BC): 95] [Hyperbarics (%BC): 95] [IV Therapy (%BC): 95] [Pulmonary Function (%BC): 95] [Pulmonary Rehabilitation (%BC): 95] [Trauma (%BC): 95] [All Other OP (%BC): 95]","count":"1 through 10","median_amount":5542.3,"10th_percentile":5542.3,"90th_percentile":5542.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs Mt","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 100] [Observation (%BC): 100] [Emergency Department (%BC): 100] [Cardiac Rehabilitation Therapy (%BC): 100] [Cardiac Stress Test (%BC): 100] [Cardiology (%BC): 100] [Echocardiology (%BC): 100] [EKG/ECG  (%BC): 100] [Electrophysiology (%BC): 100] [Electrophysiologic Ablation (%BC): 100] [Electrophysiology and Mapping Studies (%BC): 100] [Holter Monitor/Telemetry (%BC): 100] [Other Cardiac Testing (%BC): 100] [Peripheral Vascular Lab (%BC): 100] [EEG (%BC): 100] [EMG (%BC): 100] [MEG (%BC): 100] [Neuropsychological Testing and Biofeedback (%BC): 100] [Sleep Studies (%BC): 100] [Chemotherapy (%BC): 100] [Gamma Knife (%BC): 100] [Nuclear Medicine (%BC): 100] [Oncology (%BC): 100] [Radiation Therapy  (%BC): 100] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 100] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 100] [Occupational Therapy (%BC): 100] [Physical Therapy (%BC): 100] [Respiratory Services/Therapy  (%BC): 100] [Speech Therapy (%BC): 100] [Mental Health (%BC): 100] [OP ECT Mental Health (%BC): 100] [OP High Cost Drugs (%BC): 100] [Other Outpatient Implant (%BC): 100] [Hyperbarics (%BC): 100] [IV Therapy (%BC): 100] [Pulmonary Function (%BC): 100] [Pulmonary Rehabilitation (%BC): 100] [Trauma (%BC): 100] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health Network","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Peak 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Lower GI Procedures","code_information":[{"code":"5311","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"1 through 10","median_amount":1961.34,"10th_percentile":1961.34,"90th_percentile":1961.34},{"payer_name":"Allegiance","plan_name":"Mmia","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Focus","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":1897.15,"10th_percentile":1857.25,"90th_percentile":2353.76},{"payer_name":"Bcbs Mt","plan_name":"Blue Options","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":1818.1,"10th_percentile":1818.1,"90th_percentile":2148.07,"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":"Bcbs Mt","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 95] [Observation (%BC): 95] [Emergency Department (%BC): 95] [Cardiac Rehabilitation Therapy (%BC): 95] [Cardiac Stress Test (%BC): 95] [Cardiology (%BC): 95] [Echocardiology (%BC): 95] [EKG/ECG  (%BC): 95] [Electrophysiology (%BC): 95] [Electrophysiologic Ablation (%BC): 95] [Electrophysiology and Mapping Studies (%BC): 95] [Holter Monitor/Telemetry (%BC): 95] [Other Cardiac Testing (%BC): 95] [Peripheral Vascular Lab (%BC): 95] [EEG (%BC): 95] [EMG (%BC): 95] [MEG (%BC): 95] [Neuropsychological Testing and Biofeedback (%BC): 95] [Sleep Studies (%BC): 95] [Chemotherapy (%BC): 95] [Gamma Knife (%BC): 95] [Nuclear Medicine (%BC): 95] [Oncology (%BC): 95] [Radiation Therapy  (%BC): 95] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 95] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 95] [Occupational Therapy (%BC): 95] [Physical Therapy (%BC): 95] [Respiratory Services/Therapy  (%BC): 95] [Speech Therapy (%BC): 95] [Mental Health (%BC): 95] [OP ECT Mental Health (%BC): 95] [OP High Cost Drugs (%BC): 95] [Other Outpatient Implant (%BC): 95] [Hyperbarics (%BC): 95] [IV Therapy (%BC): 95] [Pulmonary Function (%BC): 95] [Pulmonary Rehabilitation (%BC): 95] [Trauma (%BC): 95] [All Other OP (%BC): 95]","count":"24","median_amount":1912.35,"10th_percentile":1873.4,"90th_percentile":2185.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs Mt","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 100] [Observation (%BC): 100] [Emergency Department (%BC): 100] [Cardiac Rehabilitation Therapy (%BC): 100] [Cardiac Stress Test (%BC): 100] [Cardiology (%BC): 100] [Echocardiology (%BC): 100] [EKG/ECG  (%BC): 100] [Electrophysiology (%BC): 100] [Electrophysiologic Ablation (%BC): 100] [Electrophysiology and Mapping Studies (%BC): 100] [Holter Monitor/Telemetry (%BC): 100] [Other Cardiac Testing (%BC): 100] [Peripheral Vascular Lab (%BC): 100] [EEG (%BC): 100] [EMG (%BC): 100] [MEG (%BC): 100] [Neuropsychological Testing and Biofeedback (%BC): 100] [Sleep Studies (%BC): 100] [Chemotherapy (%BC): 100] [Gamma Knife (%BC): 100] [Nuclear Medicine (%BC): 100] [Oncology (%BC): 100] [Radiation Therapy  (%BC): 100] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 100] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 100] [Occupational Therapy (%BC): 100] [Physical Therapy (%BC): 100] [Respiratory Services/Therapy  (%BC): 100] [Speech Therapy (%BC): 100] [Mental Health (%BC): 100] [OP ECT Mental Health (%BC): 100] [OP High Cost Drugs (%BC): 100] [Other Outpatient Implant (%BC): 100] [Hyperbarics (%BC): 100] [IV Therapy (%BC): 100] [Pulmonary Function (%BC): 100] [Pulmonary Rehabilitation (%BC): 100] [Trauma (%BC): 100] [All Other OP (%BC): 100]","count":"1 through 10","median_amount":1883.85,"10th_percentile":1883.85,"90th_percentile":1883.85,"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 Network","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":1929.01,"10th_percentile":1816.42,"90th_percentile":1966.53,"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":"Mountain Health Co-Op","plan_name":"Peak 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"1 through 10","median_amount":616.63,"10th_percentile":616.63,"90th_percentile":616.63},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":2158.4,"10th_percentile":2158.4,"90th_percentile":2158.4}]}]},{"description":"Level 2 Lower GI Procedures","code_information":[{"code":"5312","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"1 through 10","median_amount":2246.52,"10th_percentile":2071.92,"90th_percentile":3136.01},{"payer_name":"Allegiance","plan_name":"Mmia","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"1 through 10","median_amount":1972.2,"10th_percentile":1972.2,"90th_percentile":1972.2},{"payer_name":"Bcbs Mt","plan_name":"Blue Focus","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":2054.85,"10th_percentile":2050.1,"90th_percentile":2172.65},{"payer_name":"Bcbs Mt","plan_name":"Blue Options","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":1746.18,"10th_percentile":1746.18,"90th_percentile":3299.04,"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 Mt","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 95] [Observation (%BC): 95] [Emergency Department (%BC): 95] [Cardiac Rehabilitation Therapy (%BC): 95] [Cardiac Stress Test (%BC): 95] [Cardiology (%BC): 95] [Echocardiology (%BC): 95] [EKG/ECG  (%BC): 95] [Electrophysiology (%BC): 95] [Electrophysiologic Ablation (%BC): 95] [Electrophysiology and Mapping Studies (%BC): 95] [Holter Monitor/Telemetry (%BC): 95] [Other Cardiac Testing (%BC): 95] [Peripheral Vascular Lab (%BC): 95] [EEG (%BC): 95] [EMG (%BC): 95] [MEG (%BC): 95] [Neuropsychological Testing and Biofeedback (%BC): 95] [Sleep Studies (%BC): 95] [Chemotherapy (%BC): 95] [Gamma Knife (%BC): 95] [Nuclear Medicine (%BC): 95] [Oncology (%BC): 95] [Radiation Therapy  (%BC): 95] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 95] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 95] [Occupational Therapy (%BC): 95] [Physical Therapy (%BC): 95] [Respiratory Services/Therapy  (%BC): 95] [Speech Therapy (%BC): 95] [Mental Health (%BC): 95] [OP ECT Mental Health (%BC): 95] [OP High Cost Drugs (%BC): 95] [Other Outpatient Implant (%BC): 95] [Hyperbarics (%BC): 95] [IV Therapy (%BC): 95] [Pulmonary Function (%BC): 95] [Pulmonary Rehabilitation (%BC): 95] [Trauma (%BC): 95] [All Other OP (%BC): 95]","count":"21","median_amount":2072.9,"10th_percentile":2015.9,"90th_percentile":2858.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs Mt","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 100] [Observation (%BC): 100] [Emergency Department (%BC): 100] [Cardiac Rehabilitation Therapy (%BC): 100] [Cardiac Stress Test (%BC): 100] [Cardiology (%BC): 100] [Echocardiology (%BC): 100] [EKG/ECG  (%BC): 100] [Electrophysiology (%BC): 100] [Electrophysiologic Ablation (%BC): 100] [Electrophysiology and Mapping Studies (%BC): 100] [Holter Monitor/Telemetry (%BC): 100] [Other Cardiac Testing (%BC): 100] [Peripheral Vascular Lab (%BC): 100] [EEG (%BC): 100] [EMG (%BC): 100] [MEG (%BC): 100] [Neuropsychological Testing and Biofeedback (%BC): 100] [Sleep Studies (%BC): 100] [Chemotherapy (%BC): 100] [Gamma Knife (%BC): 100] [Nuclear Medicine (%BC): 100] [Oncology (%BC): 100] [Radiation Therapy  (%BC): 100] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 100] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 100] [Occupational Therapy (%BC): 100] [Physical Therapy (%BC): 100] [Respiratory Services/Therapy  (%BC): 100] [Speech Therapy (%BC): 100] [Mental Health (%BC): 100] [OP ECT Mental Health (%BC): 100] [OP High Cost Drugs (%BC): 100] [Other Outpatient Implant (%BC): 100] [Hyperbarics (%BC): 100] [IV Therapy (%BC): 100] [Pulmonary Function (%BC): 100] [Pulmonary Rehabilitation (%BC): 100] [Trauma (%BC): 100] [All Other OP (%BC): 100]","count":"1 through 10","median_amount":3175.34,"10th_percentile":3175.34,"90th_percentile":3175.34,"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 Network","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"1 through 10","median_amount":2093.26,"10th_percentile":2093.26,"90th_percentile":2093.26},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"18","median_amount":1943.58,"10th_percentile":1792.66,"90th_percentile":4331.14,"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":"Peak 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":2054.85,"10th_percentile":2054.85,"90th_percentile":2109.95}]}]},{"description":"Level 1 Urology and Related Services","code_information":[{"code":"5371","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Focus","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Options","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 95] [Observation (%BC): 95] [Emergency Department (%BC): 95] [Cardiac Rehabilitation Therapy (%BC): 95] [Cardiac Stress Test (%BC): 95] [Cardiology (%BC): 95] [Echocardiology (%BC): 95] [EKG/ECG  (%BC): 95] [Electrophysiology (%BC): 95] [Electrophysiologic Ablation (%BC): 95] [Electrophysiology and Mapping Studies (%BC): 95] [Holter Monitor/Telemetry (%BC): 95] [Other Cardiac Testing (%BC): 95] [Peripheral Vascular Lab (%BC): 95] [EEG (%BC): 95] [EMG (%BC): 95] [MEG (%BC): 95] [Neuropsychological Testing and Biofeedback (%BC): 95] [Sleep Studies (%BC): 95] [Chemotherapy (%BC): 95] [Gamma Knife (%BC): 95] [Nuclear Medicine (%BC): 95] [Oncology (%BC): 95] [Radiation Therapy  (%BC): 95] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 95] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 95] [Occupational Therapy (%BC): 95] [Physical Therapy (%BC): 95] [Respiratory Services/Therapy  (%BC): 95] [Speech Therapy (%BC): 95] [Mental Health (%BC): 95] [OP ECT Mental Health (%BC): 95] [OP High Cost Drugs (%BC): 95] [Other Outpatient Implant (%BC): 95] [Hyperbarics (%BC): 95] [IV Therapy (%BC): 95] [Pulmonary Function (%BC): 95] [Pulmonary Rehabilitation (%BC): 95] [Trauma (%BC): 95] [All Other OP (%BC): 95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 100] [Observation (%BC): 100] [Emergency Department (%BC): 100] [Cardiac Rehabilitation Therapy (%BC): 100] [Cardiac Stress Test (%BC): 100] [Cardiology (%BC): 100] [Echocardiology (%BC): 100] [EKG/ECG  (%BC): 100] [Electrophysiology (%BC): 100] [Electrophysiologic Ablation (%BC): 100] [Electrophysiology and Mapping Studies (%BC): 100] [Holter Monitor/Telemetry (%BC): 100] [Other Cardiac Testing (%BC): 100] [Peripheral Vascular Lab (%BC): 100] [EEG (%BC): 100] [EMG (%BC): 100] [MEG (%BC): 100] [Neuropsychological Testing and Biofeedback (%BC): 100] [Sleep Studies (%BC): 100] [Chemotherapy (%BC): 100] [Gamma Knife (%BC): 100] [Nuclear Medicine (%BC): 100] [Oncology (%BC): 100] [Radiation Therapy  (%BC): 100] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 100] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 100] [Occupational Therapy (%BC): 100] [Physical Therapy (%BC): 100] [Respiratory Services/Therapy  (%BC): 100] [Speech Therapy (%BC): 100] [Mental Health (%BC): 100] [OP ECT Mental Health (%BC): 100] [OP High Cost Drugs (%BC): 100] [Other Outpatient Implant (%BC): 100] [Hyperbarics (%BC): 100] [IV Therapy (%BC): 100] [Pulmonary Function (%BC): 100] [Pulmonary Rehabilitation (%BC): 100] [Trauma (%BC): 100] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health Network","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":295.5,"10th_percentile":249.67,"90th_percentile":1975.0,"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":"Peak 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"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":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Focus","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Options","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 95] [Observation (%BC): 95] [Emergency Department (%BC): 95] [Cardiac Rehabilitation Therapy (%BC): 95] [Cardiac Stress Test (%BC): 95] [Cardiology (%BC): 95] [Echocardiology (%BC): 95] [EKG/ECG  (%BC): 95] [Electrophysiology (%BC): 95] [Electrophysiologic Ablation (%BC): 95] [Electrophysiology and Mapping Studies (%BC): 95] [Holter Monitor/Telemetry (%BC): 95] [Other Cardiac Testing (%BC): 95] [Peripheral Vascular Lab (%BC): 95] [EEG (%BC): 95] [EMG (%BC): 95] [MEG (%BC): 95] [Neuropsychological Testing and Biofeedback (%BC): 95] [Sleep Studies (%BC): 95] [Chemotherapy (%BC): 95] [Gamma Knife (%BC): 95] [Nuclear Medicine (%BC): 95] [Oncology (%BC): 95] [Radiation Therapy  (%BC): 95] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 95] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 95] [Occupational Therapy (%BC): 95] [Physical Therapy (%BC): 95] [Respiratory Services/Therapy  (%BC): 95] [Speech Therapy (%BC): 95] [Mental Health (%BC): 95] [OP ECT Mental Health (%BC): 95] [OP High Cost Drugs (%BC): 95] [Other Outpatient Implant (%BC): 95] [Hyperbarics (%BC): 95] [IV Therapy (%BC): 95] [Pulmonary Function (%BC): 95] [Pulmonary Rehabilitation (%BC): 95] [Trauma (%BC): 95] [All Other OP (%BC): 95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 100] [Observation (%BC): 100] [Emergency Department (%BC): 100] [Cardiac Rehabilitation Therapy (%BC): 100] [Cardiac Stress Test (%BC): 100] [Cardiology (%BC): 100] [Echocardiology (%BC): 100] [EKG/ECG  (%BC): 100] [Electrophysiology (%BC): 100] [Electrophysiologic Ablation (%BC): 100] [Electrophysiology and Mapping Studies (%BC): 100] [Holter Monitor/Telemetry (%BC): 100] [Other Cardiac Testing (%BC): 100] [Peripheral Vascular Lab (%BC): 100] [EEG (%BC): 100] [EMG (%BC): 100] [MEG (%BC): 100] [Neuropsychological Testing and Biofeedback (%BC): 100] [Sleep Studies (%BC): 100] [Chemotherapy (%BC): 100] [Gamma Knife (%BC): 100] [Nuclear Medicine (%BC): 100] [Oncology (%BC): 100] [Radiation Therapy  (%BC): 100] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 100] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 100] [Occupational Therapy (%BC): 100] [Physical Therapy (%BC): 100] [Respiratory Services/Therapy  (%BC): 100] [Speech Therapy (%BC): 100] [Mental Health (%BC): 100] [OP ECT Mental Health (%BC): 100] [OP High Cost Drugs (%BC): 100] [Other Outpatient Implant (%BC): 100] [Hyperbarics (%BC): 100] [IV Therapy (%BC): 100] [Pulmonary Function (%BC): 100] [Pulmonary Rehabilitation (%BC): 100] [Trauma (%BC): 100] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health Network","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":244.01,"10th_percentile":244.01,"90th_percentile":244.01,"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":"Peak 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Nerve Injections","code_information":[{"code":"5441","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":269.8,"10th_percentile":269.8,"90th_percentile":269.8,"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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Focus","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":206.16,"10th_percentile":206.16,"90th_percentile":206.16},{"payer_name":"Bcbs Mt","plan_name":"Blue Options","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":329.2,"10th_percentile":329.2,"90th_percentile":329.2,"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":"Bcbs Mt","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 95] [Observation (%BC): 95] [Emergency Department (%BC): 95] [Cardiac Rehabilitation Therapy (%BC): 95] [Cardiac Stress Test (%BC): 95] [Cardiology (%BC): 95] [Echocardiology (%BC): 95] [EKG/ECG  (%BC): 95] [Electrophysiology (%BC): 95] [Electrophysiologic Ablation (%BC): 95] [Electrophysiology and Mapping Studies (%BC): 95] [Holter Monitor/Telemetry (%BC): 95] [Other Cardiac Testing (%BC): 95] [Peripheral Vascular Lab (%BC): 95] [EEG (%BC): 95] [EMG (%BC): 95] [MEG (%BC): 95] [Neuropsychological Testing and Biofeedback (%BC): 95] [Sleep Studies (%BC): 95] [Chemotherapy (%BC): 95] [Gamma Knife (%BC): 95] [Nuclear Medicine (%BC): 95] [Oncology (%BC): 95] [Radiation Therapy  (%BC): 95] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 95] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 95] [Occupational Therapy (%BC): 95] [Physical Therapy (%BC): 95] [Respiratory Services/Therapy  (%BC): 95] [Speech Therapy (%BC): 95] [Mental Health (%BC): 95] [OP ECT Mental Health (%BC): 95] [OP High Cost Drugs (%BC): 95] [Other Outpatient Implant (%BC): 95] [Hyperbarics (%BC): 95] [IV Therapy (%BC): 95] [Pulmonary Function (%BC): 95] [Pulmonary Rehabilitation (%BC): 95] [Trauma (%BC): 95] [All Other OP (%BC): 95]","count":"1 through 10","median_amount":225.99,"10th_percentile":225.99,"90th_percentile":561.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs Mt","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 100] [Observation (%BC): 100] [Emergency Department (%BC): 100] [Cardiac Rehabilitation Therapy (%BC): 100] [Cardiac Stress Test (%BC): 100] [Cardiology (%BC): 100] [Echocardiology (%BC): 100] [EKG/ECG  (%BC): 100] [Electrophysiology (%BC): 100] [Electrophysiologic Ablation (%BC): 100] [Electrophysiology and Mapping Studies (%BC): 100] [Holter Monitor/Telemetry (%BC): 100] [Other Cardiac Testing (%BC): 100] [Peripheral Vascular Lab (%BC): 100] [EEG (%BC): 100] [EMG (%BC): 100] [MEG (%BC): 100] [Neuropsychological Testing and Biofeedback (%BC): 100] [Sleep Studies (%BC): 100] [Chemotherapy (%BC): 100] [Gamma Knife (%BC): 100] [Nuclear Medicine (%BC): 100] [Oncology (%BC): 100] [Radiation Therapy  (%BC): 100] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 100] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 100] [Occupational Therapy (%BC): 100] [Physical Therapy (%BC): 100] [Respiratory Services/Therapy  (%BC): 100] [Speech Therapy (%BC): 100] [Mental Health (%BC): 100] [OP ECT Mental Health (%BC): 100] [OP High Cost Drugs (%BC): 100] [Other Outpatient Implant (%BC): 100] [Hyperbarics (%BC): 100] [IV Therapy (%BC): 100] [Pulmonary Function (%BC): 100] [Pulmonary Rehabilitation (%BC): 100] [Trauma (%BC): 100] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health Network","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"34","median_amount":244.01,"10th_percentile":192.96,"90th_percentile":506.48,"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":"Peak 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"1 through 10","median_amount":343.26,"10th_percentile":343.26,"90th_percentile":343.26},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":749.55,"10th_percentile":749.55,"90th_percentile":749.55}]}]},{"description":"Level 2 Nerve Injections","code_information":[{"code":"5442","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Focus","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Options","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 95] [Observation (%BC): 95] [Emergency Department (%BC): 95] [Cardiac Rehabilitation Therapy (%BC): 95] [Cardiac Stress Test (%BC): 95] [Cardiology (%BC): 95] [Echocardiology (%BC): 95] [EKG/ECG  (%BC): 95] [Electrophysiology (%BC): 95] [Electrophysiologic Ablation (%BC): 95] [Electrophysiology and Mapping Studies (%BC): 95] [Holter Monitor/Telemetry (%BC): 95] [Other Cardiac Testing (%BC): 95] [Peripheral Vascular Lab (%BC): 95] [EEG (%BC): 95] [EMG (%BC): 95] [MEG (%BC): 95] [Neuropsychological Testing and Biofeedback (%BC): 95] [Sleep Studies (%BC): 95] [Chemotherapy (%BC): 95] [Gamma Knife (%BC): 95] [Nuclear Medicine (%BC): 95] [Oncology (%BC): 95] [Radiation Therapy  (%BC): 95] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 95] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 95] [Occupational Therapy (%BC): 95] [Physical Therapy (%BC): 95] [Respiratory Services/Therapy  (%BC): 95] [Speech Therapy (%BC): 95] [Mental Health (%BC): 95] [OP ECT Mental Health (%BC): 95] [OP High Cost Drugs (%BC): 95] [Other Outpatient Implant (%BC): 95] [Hyperbarics (%BC): 95] [IV Therapy (%BC): 95] [Pulmonary Function (%BC): 95] [Pulmonary Rehabilitation (%BC): 95] [Trauma (%BC): 95] [All Other OP (%BC): 95]","count":"1 through 10","median_amount":957.6,"10th_percentile":957.6,"90th_percentile":957.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs Mt","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 100] [Observation (%BC): 100] [Emergency Department (%BC): 100] [Cardiac Rehabilitation Therapy (%BC): 100] [Cardiac Stress Test (%BC): 100] [Cardiology (%BC): 100] [Echocardiology (%BC): 100] [EKG/ECG  (%BC): 100] [Electrophysiology (%BC): 100] [Electrophysiologic Ablation (%BC): 100] [Electrophysiology and Mapping Studies (%BC): 100] [Holter Monitor/Telemetry (%BC): 100] [Other Cardiac Testing (%BC): 100] [Peripheral Vascular Lab (%BC): 100] [EEG (%BC): 100] [EMG (%BC): 100] [MEG (%BC): 100] [Neuropsychological Testing and Biofeedback (%BC): 100] [Sleep Studies (%BC): 100] [Chemotherapy (%BC): 100] [Gamma Knife (%BC): 100] [Nuclear Medicine (%BC): 100] [Oncology (%BC): 100] [Radiation Therapy  (%BC): 100] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 100] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 100] [Occupational Therapy (%BC): 100] [Physical Therapy (%BC): 100] [Respiratory Services/Therapy  (%BC): 100] [Speech Therapy (%BC): 100] [Mental Health (%BC): 100] [OP ECT Mental Health (%BC): 100] [OP High Cost Drugs (%BC): 100] [Other Outpatient Implant (%BC): 100] [Hyperbarics (%BC): 100] [IV Therapy (%BC): 100] [Pulmonary Function (%BC): 100] [Pulmonary Rehabilitation (%BC): 100] [Trauma (%BC): 100] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health Network","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Peak 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Imaging without Contrast","code_information":[{"code":"5521","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"1 through 10","median_amount":264.53,"10th_percentile":192.45,"90th_percentile":1193.58},{"payer_name":"Allegiance","plan_name":"Mmia","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":292.59,"10th_percentile":235.6,"90th_percentile":517.32,"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":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":235.6,"10th_percentile":221.16,"90th_percentile":268.31},{"payer_name":"Bcbs Mt","plan_name":"Blue Focus","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"29","median_amount":289.07,"10th_percentile":134.13,"90th_percentile":476.18},{"payer_name":"Bcbs Mt","plan_name":"Blue Options","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":577.82,"10th_percentile":450.92,"90th_percentile":1753.72,"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 Mt","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 95] [Observation (%BC): 95] [Emergency Department (%BC): 95] [Cardiac Rehabilitation Therapy (%BC): 95] [Cardiac Stress Test (%BC): 95] [Cardiology (%BC): 95] [Echocardiology (%BC): 95] [EKG/ECG  (%BC): 95] [Electrophysiology (%BC): 95] [Electrophysiologic Ablation (%BC): 95] [Electrophysiology and Mapping Studies (%BC): 95] [Holter Monitor/Telemetry (%BC): 95] [Other Cardiac Testing (%BC): 95] [Peripheral Vascular Lab (%BC): 95] [EEG (%BC): 95] [EMG (%BC): 95] [MEG (%BC): 95] [Neuropsychological Testing and Biofeedback (%BC): 95] [Sleep Studies (%BC): 95] [Chemotherapy (%BC): 95] [Gamma Knife (%BC): 95] [Nuclear Medicine (%BC): 95] [Oncology (%BC): 95] [Radiation Therapy  (%BC): 95] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 95] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 95] [Occupational Therapy (%BC): 95] [Physical Therapy (%BC): 95] [Respiratory Services/Therapy  (%BC): 95] [Speech Therapy (%BC): 95] [Mental Health (%BC): 95] [OP ECT Mental Health (%BC): 95] [OP High Cost Drugs (%BC): 95] [Other Outpatient Implant (%BC): 95] [Hyperbarics (%BC): 95] [IV Therapy (%BC): 95] [Pulmonary Function (%BC): 95] [Pulmonary Rehabilitation (%BC): 95] [Trauma (%BC): 95] [All Other OP (%BC): 95]","count":"79","median_amount":80.18,"10th_percentile":61.52,"90th_percentile":292.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs Mt","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 100] [Observation (%BC): 100] [Emergency Department (%BC): 100] [Cardiac Rehabilitation Therapy (%BC): 100] [Cardiac Stress Test (%BC): 100] [Cardiology (%BC): 100] [Echocardiology (%BC): 100] [EKG/ECG  (%BC): 100] [Electrophysiology (%BC): 100] [Electrophysiologic Ablation (%BC): 100] [Electrophysiology and Mapping Studies (%BC): 100] [Holter Monitor/Telemetry (%BC): 100] [Other Cardiac Testing (%BC): 100] [Peripheral Vascular Lab (%BC): 100] [EEG (%BC): 100] [EMG (%BC): 100] [MEG (%BC): 100] [Neuropsychological Testing and Biofeedback (%BC): 100] [Sleep Studies (%BC): 100] [Chemotherapy (%BC): 100] [Gamma Knife (%BC): 100] [Nuclear Medicine (%BC): 100] [Oncology (%BC): 100] [Radiation Therapy  (%BC): 100] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 100] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 100] [Occupational Therapy (%BC): 100] [Physical Therapy (%BC): 100] [Respiratory Services/Therapy  (%BC): 100] [Speech Therapy (%BC): 100] [Mental Health (%BC): 100] [OP ECT Mental Health (%BC): 100] [OP High Cost Drugs (%BC): 100] [Other Outpatient Implant (%BC): 100] [Hyperbarics (%BC): 100] [IV Therapy (%BC): 100] [Pulmonary Function (%BC): 100] [Pulmonary Rehabilitation (%BC): 100] [Trauma (%BC): 100] [All Other OP (%BC): 100]","count":"1 through 10","median_amount":87.54,"10th_percentile":87.54,"90th_percentile":89.92,"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":"First Choice Health Network","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"1 through 10","median_amount":301.57,"10th_percentile":301.57,"90th_percentile":301.57},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"86","median_amount":197.48,"10th_percentile":53.75,"90th_percentile":476.4,"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":"Peak Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":287.88,"10th_percentile":287.88,"90th_percentile":287.88},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":363.72,"10th_percentile":363.72,"90th_percentile":461.28,"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":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"11","median_amount":283.21,"10th_percentile":85.45,"90th_percentile":308.25},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"18","median_amount":291.68,"10th_percentile":70.09,"90th_percentile":635.45}]}]},{"description":"Level 2 Imaging without Contrast","code_information":[{"code":"5522","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"1 through 10","median_amount":788.6,"10th_percentile":788.6,"90th_percentile":788.6},{"payer_name":"Allegiance","plan_name":"Mmia","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":708.35,"10th_percentile":708.35,"90th_percentile":708.35,"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":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":827.32,"10th_percentile":498.22,"90th_percentile":1050.33},{"payer_name":"Bcbs Mt","plan_name":"Blue Focus","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"18","median_amount":706.8,"10th_percentile":324.9,"90th_percentile":1218.75},{"payer_name":"Bcbs Mt","plan_name":"Blue Options","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"11","median_amount":463.45,"10th_percentile":232.72,"90th_percentile":1239.81,"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 Mt","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 95] [Observation (%BC): 95] [Emergency Department (%BC): 95] [Cardiac Rehabilitation Therapy (%BC): 95] [Cardiac Stress Test (%BC): 95] [Cardiology (%BC): 95] [Echocardiology (%BC): 95] [EKG/ECG  (%BC): 95] [Electrophysiology (%BC): 95] [Electrophysiologic Ablation (%BC): 95] [Electrophysiology and Mapping Studies (%BC): 95] [Holter Monitor/Telemetry (%BC): 95] [Other Cardiac Testing (%BC): 95] [Peripheral Vascular Lab (%BC): 95] [EEG (%BC): 95] [EMG (%BC): 95] [MEG (%BC): 95] [Neuropsychological Testing and Biofeedback (%BC): 95] [Sleep Studies (%BC): 95] [Chemotherapy (%BC): 95] [Gamma Knife (%BC): 95] [Nuclear Medicine (%BC): 95] [Oncology (%BC): 95] [Radiation Therapy  (%BC): 95] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 95] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 95] [Occupational Therapy (%BC): 95] [Physical Therapy (%BC): 95] [Respiratory Services/Therapy  (%BC): 95] [Speech Therapy (%BC): 95] [Mental Health (%BC): 95] [OP ECT Mental Health (%BC): 95] [OP High Cost Drugs (%BC): 95] [Other Outpatient Implant (%BC): 95] [Hyperbarics (%BC): 95] [IV Therapy (%BC): 95] [Pulmonary Function (%BC): 95] [Pulmonary Rehabilitation (%BC): 95] [Trauma (%BC): 95] [All Other OP (%BC): 95]","count":"51","median_amount":151.46,"10th_percentile":70.2,"90th_percentile":279.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs Mt","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 100] [Observation (%BC): 100] [Emergency Department (%BC): 100] [Cardiac Rehabilitation Therapy (%BC): 100] [Cardiac Stress Test (%BC): 100] [Cardiology (%BC): 100] [Echocardiology (%BC): 100] [EKG/ECG  (%BC): 100] [Electrophysiology (%BC): 100] [Electrophysiologic Ablation (%BC): 100] [Electrophysiology and Mapping Studies (%BC): 100] [Holter Monitor/Telemetry (%BC): 100] [Other Cardiac Testing (%BC): 100] [Peripheral Vascular Lab (%BC): 100] [EEG (%BC): 100] [EMG (%BC): 100] [MEG (%BC): 100] [Neuropsychological Testing and Biofeedback (%BC): 100] [Sleep Studies (%BC): 100] [Chemotherapy (%BC): 100] [Gamma Knife (%BC): 100] [Nuclear Medicine (%BC): 100] [Oncology (%BC): 100] [Radiation Therapy  (%BC): 100] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 100] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 100] [Occupational Therapy (%BC): 100] [Physical Therapy (%BC): 100] [Respiratory Services/Therapy  (%BC): 100] [Speech Therapy (%BC): 100] [Mental Health (%BC): 100] [OP ECT Mental Health (%BC): 100] [OP High Cost Drugs (%BC): 100] [Other Outpatient Implant (%BC): 100] [Hyperbarics (%BC): 100] [IV Therapy (%BC): 100] [Pulmonary Function (%BC): 100] [Pulmonary Rehabilitation (%BC): 100] [Trauma (%BC): 100] [All Other OP (%BC): 100]","count":"1 through 10","median_amount":818.0,"10th_percentile":818.0,"90th_percentile":818.0,"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 Network","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"74","median_amount":396.71,"10th_percentile":127.51,"90th_percentile":1041.75,"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":"Peak 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"1 through 10","median_amount":390.45,"10th_percentile":390.45,"90th_percentile":512.05},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"11","median_amount":491.15,"10th_percentile":324.9,"90th_percentile":1543.7}]}]},{"description":"Level 3 Imaging without Contrast","code_information":[{"code":"5523","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"1 through 10","median_amount":1156.17,"10th_percentile":1156.17,"90th_percentile":1156.17},{"payer_name":"Allegiance","plan_name":"Mmia","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":1518.1,"10th_percentile":1446.85,"90th_percentile":2628.92,"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":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":331.55,"10th_percentile":331.55,"90th_percentile":331.55},{"payer_name":"Bcbs Mt","plan_name":"Blue Focus","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":855.58,"10th_percentile":855.58,"90th_percentile":855.58},{"payer_name":"Bcbs Mt","plan_name":"Blue Options","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":667.88,"10th_percentile":667.88,"90th_percentile":904.52,"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":"Bcbs Mt","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 95] [Observation (%BC): 95] [Emergency Department (%BC): 95] [Cardiac Rehabilitation Therapy (%BC): 95] [Cardiac Stress Test (%BC): 95] [Cardiology (%BC): 95] [Echocardiology (%BC): 95] [EKG/ECG  (%BC): 95] [Electrophysiology (%BC): 95] [Electrophysiologic Ablation (%BC): 95] [Electrophysiology and Mapping Studies (%BC): 95] [Holter Monitor/Telemetry (%BC): 95] [Other Cardiac Testing (%BC): 95] [Peripheral Vascular Lab (%BC): 95] [EEG (%BC): 95] [EMG (%BC): 95] [MEG (%BC): 95] [Neuropsychological Testing and Biofeedback (%BC): 95] [Sleep Studies (%BC): 95] [Chemotherapy (%BC): 95] [Gamma Knife (%BC): 95] [Nuclear Medicine (%BC): 95] [Oncology (%BC): 95] [Radiation Therapy  (%BC): 95] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 95] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 95] [Occupational Therapy (%BC): 95] [Physical Therapy (%BC): 95] [Respiratory Services/Therapy  (%BC): 95] [Speech Therapy (%BC): 95] [Mental Health (%BC): 95] [OP ECT Mental Health (%BC): 95] [OP High Cost Drugs (%BC): 95] [Other Outpatient Implant (%BC): 95] [Hyperbarics (%BC): 95] [IV Therapy (%BC): 95] [Pulmonary Function (%BC): 95] [Pulmonary Rehabilitation (%BC): 95] [Trauma (%BC): 95] [All Other OP (%BC): 95]","count":"16","median_amount":328.31,"10th_percentile":269.65,"90th_percentile":410.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs Mt","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 100] [Observation (%BC): 100] [Emergency Department (%BC): 100] [Cardiac Rehabilitation Therapy (%BC): 100] [Cardiac Stress Test (%BC): 100] [Cardiology (%BC): 100] [Echocardiology (%BC): 100] [EKG/ECG  (%BC): 100] [Electrophysiology (%BC): 100] [Electrophysiologic Ablation (%BC): 100] [Electrophysiology and Mapping Studies (%BC): 100] [Holter Monitor/Telemetry (%BC): 100] [Other Cardiac Testing (%BC): 100] [Peripheral Vascular Lab (%BC): 100] [EEG (%BC): 100] [EMG (%BC): 100] [MEG (%BC): 100] [Neuropsychological Testing and Biofeedback (%BC): 100] [Sleep Studies (%BC): 100] [Chemotherapy (%BC): 100] [Gamma Knife (%BC): 100] [Nuclear Medicine (%BC): 100] [Oncology (%BC): 100] [Radiation Therapy  (%BC): 100] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 100] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 100] [Occupational Therapy (%BC): 100] [Physical Therapy (%BC): 100] [Respiratory Services/Therapy  (%BC): 100] [Speech Therapy (%BC): 100] [Mental Health (%BC): 100] [OP ECT Mental Health (%BC): 100] [OP High Cost Drugs (%BC): 100] [Other Outpatient Implant (%BC): 100] [Hyperbarics (%BC): 100] [IV Therapy (%BC): 100] [Pulmonary Function (%BC): 100] [Pulmonary Rehabilitation (%BC): 100] [Trauma (%BC): 100] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health Network","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"27","median_amount":1079.19,"10th_percentile":729.19,"90th_percentile":1163.46,"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":"Mountain Health Co-Op","plan_name":"Peak 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":1464.36,"10th_percentile":1464.36,"90th_percentile":1464.36}]}]},{"description":"Level 4 Imaging without Contrast","code_information":[{"code":"5524","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Focus","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":2024.45,"10th_percentile":2024.45,"90th_percentile":2269.55},{"payer_name":"Bcbs Mt","plan_name":"Blue Options","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 95] [Observation (%BC): 95] [Emergency Department (%BC): 95] [Cardiac Rehabilitation Therapy (%BC): 95] [Cardiac Stress Test (%BC): 95] [Cardiology (%BC): 95] [Echocardiology (%BC): 95] [EKG/ECG  (%BC): 95] [Electrophysiology (%BC): 95] [Electrophysiologic Ablation (%BC): 95] [Electrophysiology and Mapping Studies (%BC): 95] [Holter Monitor/Telemetry (%BC): 95] [Other Cardiac Testing (%BC): 95] [Peripheral Vascular Lab (%BC): 95] [EEG (%BC): 95] [EMG (%BC): 95] [MEG (%BC): 95] [Neuropsychological Testing and Biofeedback (%BC): 95] [Sleep Studies (%BC): 95] [Chemotherapy (%BC): 95] [Gamma Knife (%BC): 95] [Nuclear Medicine (%BC): 95] [Oncology (%BC): 95] [Radiation Therapy  (%BC): 95] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 95] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 95] [Occupational Therapy (%BC): 95] [Physical Therapy (%BC): 95] [Respiratory Services/Therapy  (%BC): 95] [Speech Therapy (%BC): 95] [Mental Health (%BC): 95] [OP ECT Mental Health (%BC): 95] [OP High Cost Drugs (%BC): 95] [Other Outpatient Implant (%BC): 95] [Hyperbarics (%BC): 95] [IV Therapy (%BC): 95] [Pulmonary Function (%BC): 95] [Pulmonary Rehabilitation (%BC): 95] [Trauma (%BC): 95] [All Other OP (%BC): 95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 100] [Observation (%BC): 100] [Emergency Department (%BC): 100] [Cardiac Rehabilitation Therapy (%BC): 100] [Cardiac Stress Test (%BC): 100] [Cardiology (%BC): 100] [Echocardiology (%BC): 100] [EKG/ECG  (%BC): 100] [Electrophysiology (%BC): 100] [Electrophysiologic Ablation (%BC): 100] [Electrophysiology and Mapping Studies (%BC): 100] [Holter Monitor/Telemetry (%BC): 100] [Other Cardiac Testing (%BC): 100] [Peripheral Vascular Lab (%BC): 100] [EEG (%BC): 100] [EMG (%BC): 100] [MEG (%BC): 100] [Neuropsychological Testing and Biofeedback (%BC): 100] [Sleep Studies (%BC): 100] [Chemotherapy (%BC): 100] [Gamma Knife (%BC): 100] [Nuclear Medicine (%BC): 100] [Oncology (%BC): 100] [Radiation Therapy  (%BC): 100] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 100] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 100] [Occupational Therapy (%BC): 100] [Physical Therapy (%BC): 100] [Respiratory Services/Therapy  (%BC): 100] [Speech Therapy (%BC): 100] [Mental Health (%BC): 100] [OP ECT Mental Health (%BC): 100] [OP High Cost Drugs (%BC): 100] [Other Outpatient Implant (%BC): 100] [Hyperbarics (%BC): 100] [IV Therapy (%BC): 100] [Pulmonary Function (%BC): 100] [Pulmonary Rehabilitation (%BC): 100] [Trauma (%BC): 100] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health Network","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"13","median_amount":1402.21,"10th_percentile":998.21,"90th_percentile":6901.73,"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":"Peak 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Imaging with Contrast","code_information":[{"code":"5571","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":1848.7,"10th_percentile":1848.7,"90th_percentile":1848.7,"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":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Focus","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Options","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":3941.32,"10th_percentile":3941.32,"90th_percentile":3941.32,"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 Mt","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 95] [Observation (%BC): 95] [Emergency Department (%BC): 95] [Cardiac Rehabilitation Therapy (%BC): 95] [Cardiac Stress Test (%BC): 95] [Cardiology (%BC): 95] [Echocardiology (%BC): 95] [EKG/ECG  (%BC): 95] [Electrophysiology (%BC): 95] [Electrophysiologic Ablation (%BC): 95] [Electrophysiology and Mapping Studies (%BC): 95] [Holter Monitor/Telemetry (%BC): 95] [Other Cardiac Testing (%BC): 95] [Peripheral Vascular Lab (%BC): 95] [EEG (%BC): 95] [EMG (%BC): 95] [MEG (%BC): 95] [Neuropsychological Testing and Biofeedback (%BC): 95] [Sleep Studies (%BC): 95] [Chemotherapy (%BC): 95] [Gamma Knife (%BC): 95] [Nuclear Medicine (%BC): 95] [Oncology (%BC): 95] [Radiation Therapy  (%BC): 95] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 95] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 95] [Occupational Therapy (%BC): 95] [Physical Therapy (%BC): 95] [Respiratory Services/Therapy  (%BC): 95] [Speech Therapy (%BC): 95] [Mental Health (%BC): 95] [OP ECT Mental Health (%BC): 95] [OP High Cost Drugs (%BC): 95] [Other Outpatient Implant (%BC): 95] [Hyperbarics (%BC): 95] [IV Therapy (%BC): 95] [Pulmonary Function (%BC): 95] [Pulmonary Rehabilitation (%BC): 95] [Trauma (%BC): 95] [All Other OP (%BC): 95]","count":"1 through 10","median_amount":422.59,"10th_percentile":422.59,"90th_percentile":422.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs Mt","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 100] [Observation (%BC): 100] [Emergency Department (%BC): 100] [Cardiac Rehabilitation Therapy (%BC): 100] [Cardiac Stress Test (%BC): 100] [Cardiology (%BC): 100] [Echocardiology (%BC): 100] [EKG/ECG  (%BC): 100] [Electrophysiology (%BC): 100] [Electrophysiologic Ablation (%BC): 100] [Electrophysiology and Mapping Studies (%BC): 100] [Holter Monitor/Telemetry (%BC): 100] [Other Cardiac Testing (%BC): 100] [Peripheral Vascular Lab (%BC): 100] [EEG (%BC): 100] [EMG (%BC): 100] [MEG (%BC): 100] [Neuropsychological Testing and Biofeedback (%BC): 100] [Sleep Studies (%BC): 100] [Chemotherapy (%BC): 100] [Gamma Knife (%BC): 100] [Nuclear Medicine (%BC): 100] [Oncology (%BC): 100] [Radiation Therapy  (%BC): 100] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 100] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 100] [Occupational Therapy (%BC): 100] [Physical Therapy (%BC): 100] [Respiratory Services/Therapy  (%BC): 100] [Speech Therapy (%BC): 100] [Mental Health (%BC): 100] [OP ECT Mental Health (%BC): 100] [OP High Cost Drugs (%BC): 100] [Other Outpatient Implant (%BC): 100] [Hyperbarics (%BC): 100] [IV Therapy (%BC): 100] [Pulmonary Function (%BC): 100] [Pulmonary Rehabilitation (%BC): 100] [Trauma (%BC): 100] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health Network","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":3623.45,"10th_percentile":1485.5,"90th_percentile":4716.6,"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":"Peak 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"1 through 10","median_amount":2032.17,"10th_percentile":2032.17,"90th_percentile":2032.17},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":1703.96,"10th_percentile":1703.96,"90th_percentile":1703.96}]}]},{"description":"Level 2 Imaging with Contrast","code_information":[{"code":"5572","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"1 through 10","median_amount":3618.1,"10th_percentile":3618.1,"90th_percentile":3618.1},{"payer_name":"Allegiance","plan_name":"Mmia","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Focus","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":4330.29,"10th_percentile":3648.95,"90th_percentile":6334.72},{"payer_name":"Bcbs Mt","plan_name":"Blue Options","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":1443.04,"10th_percentile":1443.04,"90th_percentile":1443.04,"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 Mt","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 95] [Observation (%BC): 95] [Emergency Department (%BC): 95] [Cardiac Rehabilitation Therapy (%BC): 95] [Cardiac Stress Test (%BC): 95] [Cardiology (%BC): 95] [Echocardiology (%BC): 95] [EKG/ECG  (%BC): 95] [Electrophysiology (%BC): 95] [Electrophysiologic Ablation (%BC): 95] [Electrophysiology and Mapping Studies (%BC): 95] [Holter Monitor/Telemetry (%BC): 95] [Other Cardiac Testing (%BC): 95] [Peripheral Vascular Lab (%BC): 95] [EEG (%BC): 95] [EMG (%BC): 95] [MEG (%BC): 95] [Neuropsychological Testing and Biofeedback (%BC): 95] [Sleep Studies (%BC): 95] [Chemotherapy (%BC): 95] [Gamma Knife (%BC): 95] [Nuclear Medicine (%BC): 95] [Oncology (%BC): 95] [Radiation Therapy  (%BC): 95] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 95] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 95] [Occupational Therapy (%BC): 95] [Physical Therapy (%BC): 95] [Respiratory Services/Therapy  (%BC): 95] [Speech Therapy (%BC): 95] [Mental Health (%BC): 95] [OP ECT Mental Health (%BC): 95] [OP High Cost Drugs (%BC): 95] [Other Outpatient Implant (%BC): 95] [Hyperbarics (%BC): 95] [IV Therapy (%BC): 95] [Pulmonary Function (%BC): 95] [Pulmonary Rehabilitation (%BC): 95] [Trauma (%BC): 95] [All Other OP (%BC): 95]","count":"1 through 10","median_amount":2952.63,"10th_percentile":625.69,"90th_percentile":4566.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs Mt","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 100] [Observation (%BC): 100] [Emergency Department (%BC): 100] [Cardiac Rehabilitation Therapy (%BC): 100] [Cardiac Stress Test (%BC): 100] [Cardiology (%BC): 100] [Echocardiology (%BC): 100] [EKG/ECG  (%BC): 100] [Electrophysiology (%BC): 100] [Electrophysiologic Ablation (%BC): 100] [Electrophysiology and Mapping Studies (%BC): 100] [Holter Monitor/Telemetry (%BC): 100] [Other Cardiac Testing (%BC): 100] [Peripheral Vascular Lab (%BC): 100] [EEG (%BC): 100] [EMG (%BC): 100] [MEG (%BC): 100] [Neuropsychological Testing and Biofeedback (%BC): 100] [Sleep Studies (%BC): 100] [Chemotherapy (%BC): 100] [Gamma Knife (%BC): 100] [Nuclear Medicine (%BC): 100] [Oncology (%BC): 100] [Radiation Therapy  (%BC): 100] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 100] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 100] [Occupational Therapy (%BC): 100] [Physical Therapy (%BC): 100] [Respiratory Services/Therapy  (%BC): 100] [Speech Therapy (%BC): 100] [Mental Health (%BC): 100] [OP ECT Mental Health (%BC): 100] [OP High Cost Drugs (%BC): 100] [Other Outpatient Implant (%BC): 100] [Hyperbarics (%BC): 100] [IV Therapy (%BC): 100] [Pulmonary Function (%BC): 100] [Pulmonary Rehabilitation (%BC): 100] [Trauma (%BC): 100] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health Network","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"17","median_amount":2198.21,"10th_percentile":1425.52,"90th_percentile":4044.29,"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":"Peak 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"1 through 10","median_amount":3152.23,"10th_percentile":3152.23,"90th_percentile":3332.59},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":3521.64,"10th_percentile":3521.64,"90th_percentile":3521.64}]}]},{"description":"Level 1 Pathology","code_information":[{"code":"5671","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Focus","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Options","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":59.6,"10th_percentile":59.6,"90th_percentile":59.6,"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 Mt","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 95] [Observation (%BC): 95] [Emergency Department (%BC): 95] [Cardiac Rehabilitation Therapy (%BC): 95] [Cardiac Stress Test (%BC): 95] [Cardiology (%BC): 95] [Echocardiology (%BC): 95] [EKG/ECG  (%BC): 95] [Electrophysiology (%BC): 95] [Electrophysiologic Ablation (%BC): 95] [Electrophysiology and Mapping Studies (%BC): 95] [Holter Monitor/Telemetry (%BC): 95] [Other Cardiac Testing (%BC): 95] [Peripheral Vascular Lab (%BC): 95] [EEG (%BC): 95] [EMG (%BC): 95] [MEG (%BC): 95] [Neuropsychological Testing and Biofeedback (%BC): 95] [Sleep Studies (%BC): 95] [Chemotherapy (%BC): 95] [Gamma Knife (%BC): 95] [Nuclear Medicine (%BC): 95] [Oncology (%BC): 95] [Radiation Therapy  (%BC): 95] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 95] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 95] [Occupational Therapy (%BC): 95] [Physical Therapy (%BC): 95] [Respiratory Services/Therapy  (%BC): 95] [Speech Therapy (%BC): 95] [Mental Health (%BC): 95] [OP ECT Mental Health (%BC): 95] [OP High Cost Drugs (%BC): 95] [Other Outpatient Implant (%BC): 95] [Hyperbarics (%BC): 95] [IV Therapy (%BC): 95] [Pulmonary Function (%BC): 95] [Pulmonary Rehabilitation (%BC): 95] [Trauma (%BC): 95] [All Other OP (%BC): 95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 100] [Observation (%BC): 100] [Emergency Department (%BC): 100] [Cardiac Rehabilitation Therapy (%BC): 100] [Cardiac Stress Test (%BC): 100] [Cardiology (%BC): 100] [Echocardiology (%BC): 100] [EKG/ECG  (%BC): 100] [Electrophysiology (%BC): 100] [Electrophysiologic Ablation (%BC): 100] [Electrophysiology and Mapping Studies (%BC): 100] [Holter Monitor/Telemetry (%BC): 100] [Other Cardiac Testing (%BC): 100] [Peripheral Vascular Lab (%BC): 100] [EEG (%BC): 100] [EMG (%BC): 100] [MEG (%BC): 100] [Neuropsychological Testing and Biofeedback (%BC): 100] [Sleep Studies (%BC): 100] [Chemotherapy (%BC): 100] [Gamma Knife (%BC): 100] [Nuclear Medicine (%BC): 100] [Oncology (%BC): 100] [Radiation Therapy  (%BC): 100] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 100] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 100] [Occupational Therapy (%BC): 100] [Physical Therapy (%BC): 100] [Respiratory Services/Therapy  (%BC): 100] [Speech Therapy (%BC): 100] [Mental Health (%BC): 100] [OP ECT Mental Health (%BC): 100] [OP High Cost Drugs (%BC): 100] [Other Outpatient Implant (%BC): 100] [Hyperbarics (%BC): 100] [IV Therapy (%BC): 100] [Pulmonary Function (%BC): 100] [Pulmonary Rehabilitation (%BC): 100] [Trauma (%BC): 100] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health Network","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":124.75,"10th_percentile":124.75,"90th_percentile":124.75,"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":"Peak 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"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":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Focus","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Options","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 95] [Observation (%BC): 95] [Emergency Department (%BC): 95] [Cardiac Rehabilitation Therapy (%BC): 95] [Cardiac Stress Test (%BC): 95] [Cardiology (%BC): 95] [Echocardiology (%BC): 95] [EKG/ECG  (%BC): 95] [Electrophysiology (%BC): 95] [Electrophysiologic Ablation (%BC): 95] [Electrophysiology and Mapping Studies (%BC): 95] [Holter Monitor/Telemetry (%BC): 95] [Other Cardiac Testing (%BC): 95] [Peripheral Vascular Lab (%BC): 95] [EEG (%BC): 95] [EMG (%BC): 95] [MEG (%BC): 95] [Neuropsychological Testing and Biofeedback (%BC): 95] [Sleep Studies (%BC): 95] [Chemotherapy (%BC): 95] [Gamma Knife (%BC): 95] [Nuclear Medicine (%BC): 95] [Oncology (%BC): 95] [Radiation Therapy  (%BC): 95] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 95] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 95] [Occupational Therapy (%BC): 95] [Physical Therapy (%BC): 95] [Respiratory Services/Therapy  (%BC): 95] [Speech Therapy (%BC): 95] [Mental Health (%BC): 95] [OP ECT Mental Health (%BC): 95] [OP High Cost Drugs (%BC): 95] [Other Outpatient Implant (%BC): 95] [Hyperbarics (%BC): 95] [IV Therapy (%BC): 95] [Pulmonary Function (%BC): 95] [Pulmonary Rehabilitation (%BC): 95] [Trauma (%BC): 95] [All Other OP (%BC): 95]","count":"1 through 10","median_amount":6980.89,"10th_percentile":6980.89,"90th_percentile":6980.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs Mt","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 100] [Observation (%BC): 100] [Emergency Department (%BC): 100] [Cardiac Rehabilitation Therapy (%BC): 100] [Cardiac Stress Test (%BC): 100] [Cardiology (%BC): 100] [Echocardiology (%BC): 100] [EKG/ECG  (%BC): 100] [Electrophysiology (%BC): 100] [Electrophysiologic Ablation (%BC): 100] [Electrophysiology and Mapping Studies (%BC): 100] [Holter Monitor/Telemetry (%BC): 100] [Other Cardiac Testing (%BC): 100] [Peripheral Vascular Lab (%BC): 100] [EEG (%BC): 100] [EMG (%BC): 100] [MEG (%BC): 100] [Neuropsychological Testing and Biofeedback (%BC): 100] [Sleep Studies (%BC): 100] [Chemotherapy (%BC): 100] [Gamma Knife (%BC): 100] [Nuclear Medicine (%BC): 100] [Oncology (%BC): 100] [Radiation Therapy  (%BC): 100] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 100] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 100] [Occupational Therapy (%BC): 100] [Physical Therapy (%BC): 100] [Respiratory Services/Therapy  (%BC): 100] [Speech Therapy (%BC): 100] [Mental Health (%BC): 100] [OP ECT Mental Health (%BC): 100] [OP High Cost Drugs (%BC): 100] [Other Outpatient Implant (%BC): 100] [Hyperbarics (%BC): 100] [IV Therapy (%BC): 100] [Pulmonary Function (%BC): 100] [Pulmonary Rehabilitation (%BC): 100] [Trauma (%BC): 100] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health Network","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":6011.83,"10th_percentile":6011.83,"90th_percentile":11129.5,"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":"Mountain Health Co-Op","plan_name":"Peak 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Drug Administration","code_information":[{"code":"5692","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Focus","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":328.95,"10th_percentile":328.95,"90th_percentile":328.95},{"payer_name":"Bcbs Mt","plan_name":"Blue Options","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":249.2,"10th_percentile":159.02,"90th_percentile":332.2,"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":"Bcbs Mt","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 95] [Observation (%BC): 95] [Emergency Department (%BC): 95] [Cardiac Rehabilitation Therapy (%BC): 95] [Cardiac Stress Test (%BC): 95] [Cardiology (%BC): 95] [Echocardiology (%BC): 95] [EKG/ECG  (%BC): 95] [Electrophysiology (%BC): 95] [Electrophysiologic Ablation (%BC): 95] [Electrophysiology and Mapping Studies (%BC): 95] [Holter Monitor/Telemetry (%BC): 95] [Other Cardiac Testing (%BC): 95] [Peripheral Vascular Lab (%BC): 95] [EEG (%BC): 95] [EMG (%BC): 95] [MEG (%BC): 95] [Neuropsychological Testing and Biofeedback (%BC): 95] [Sleep Studies (%BC): 95] [Chemotherapy (%BC): 95] [Gamma Knife (%BC): 95] [Nuclear Medicine (%BC): 95] [Oncology (%BC): 95] [Radiation Therapy  (%BC): 95] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 95] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 95] [Occupational Therapy (%BC): 95] [Physical Therapy (%BC): 95] [Respiratory Services/Therapy  (%BC): 95] [Speech Therapy (%BC): 95] [Mental Health (%BC): 95] [OP ECT Mental Health (%BC): 95] [OP High Cost Drugs (%BC): 95] [Other Outpatient Implant (%BC): 95] [Hyperbarics (%BC): 95] [IV Therapy (%BC): 95] [Pulmonary Function (%BC): 95] [Pulmonary Rehabilitation (%BC): 95] [Trauma (%BC): 95] [All Other OP (%BC): 95]","count":"13","median_amount":2371.96,"10th_percentile":215.65,"90th_percentile":4506.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs Mt","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 100] [Observation (%BC): 100] [Emergency Department (%BC): 100] [Cardiac Rehabilitation Therapy (%BC): 100] [Cardiac Stress Test (%BC): 100] [Cardiology (%BC): 100] [Echocardiology (%BC): 100] [EKG/ECG  (%BC): 100] [Electrophysiology (%BC): 100] [Electrophysiologic Ablation (%BC): 100] [Electrophysiology and Mapping Studies (%BC): 100] [Holter Monitor/Telemetry (%BC): 100] [Other Cardiac Testing (%BC): 100] [Peripheral Vascular Lab (%BC): 100] [EEG (%BC): 100] [EMG (%BC): 100] [MEG (%BC): 100] [Neuropsychological Testing and Biofeedback (%BC): 100] [Sleep Studies (%BC): 100] [Chemotherapy (%BC): 100] [Gamma Knife (%BC): 100] [Nuclear Medicine (%BC): 100] [Oncology (%BC): 100] [Radiation Therapy  (%BC): 100] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 100] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 100] [Occupational Therapy (%BC): 100] [Physical Therapy (%BC): 100] [Respiratory Services/Therapy  (%BC): 100] [Speech Therapy (%BC): 100] [Mental Health (%BC): 100] [OP ECT Mental Health (%BC): 100] [OP High Cost Drugs (%BC): 100] [Other Outpatient Implant (%BC): 100] [Hyperbarics (%BC): 100] [IV Therapy (%BC): 100] [Pulmonary Function (%BC): 100] [Pulmonary Rehabilitation (%BC): 100] [Trauma (%BC): 100] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health Network","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"80","median_amount":244.01,"10th_percentile":130.25,"90th_percentile":371.66,"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":"Mountain Health Co-Op","plan_name":"Peak 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Drug Administration","code_information":[{"code":"5693","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Focus","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Options","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 95] [Observation (%BC): 95] [Emergency Department (%BC): 95] [Cardiac Rehabilitation Therapy (%BC): 95] [Cardiac Stress Test (%BC): 95] [Cardiology (%BC): 95] [Echocardiology (%BC): 95] [EKG/ECG  (%BC): 95] [Electrophysiology (%BC): 95] [Electrophysiologic Ablation (%BC): 95] [Electrophysiology and Mapping Studies (%BC): 95] [Holter Monitor/Telemetry (%BC): 95] [Other Cardiac Testing (%BC): 95] [Peripheral Vascular Lab (%BC): 95] [EEG (%BC): 95] [EMG (%BC): 95] [MEG (%BC): 95] [Neuropsychological Testing and Biofeedback (%BC): 95] [Sleep Studies (%BC): 95] [Chemotherapy (%BC): 95] [Gamma Knife (%BC): 95] [Nuclear Medicine (%BC): 95] [Oncology (%BC): 95] [Radiation Therapy  (%BC): 95] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 95] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 95] [Occupational Therapy (%BC): 95] [Physical Therapy (%BC): 95] [Respiratory Services/Therapy  (%BC): 95] [Speech Therapy (%BC): 95] [Mental Health (%BC): 95] [OP ECT Mental Health (%BC): 95] [OP High Cost Drugs (%BC): 95] [Other Outpatient Implant (%BC): 95] [Hyperbarics (%BC): 95] [IV Therapy (%BC): 95] [Pulmonary Function (%BC): 95] [Pulmonary Rehabilitation (%BC): 95] [Trauma (%BC): 95] [All Other OP (%BC): 95]","count":"1 through 10","median_amount":950.95,"10th_percentile":416.21,"90th_percentile":1093.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs Mt","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 100] [Observation (%BC): 100] [Emergency Department (%BC): 100] [Cardiac Rehabilitation Therapy (%BC): 100] [Cardiac Stress Test (%BC): 100] [Cardiology (%BC): 100] [Echocardiology (%BC): 100] [EKG/ECG  (%BC): 100] [Electrophysiology (%BC): 100] [Electrophysiologic Ablation (%BC): 100] [Electrophysiology and Mapping Studies (%BC): 100] [Holter Monitor/Telemetry (%BC): 100] [Other Cardiac Testing (%BC): 100] [Peripheral Vascular Lab (%BC): 100] [EEG (%BC): 100] [EMG (%BC): 100] [MEG (%BC): 100] [Neuropsychological Testing and Biofeedback (%BC): 100] [Sleep Studies (%BC): 100] [Chemotherapy (%BC): 100] [Gamma Knife (%BC): 100] [Nuclear Medicine (%BC): 100] [Oncology (%BC): 100] [Radiation Therapy  (%BC): 100] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 100] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 100] [Occupational Therapy (%BC): 100] [Physical Therapy (%BC): 100] [Respiratory Services/Therapy  (%BC): 100] [Speech Therapy (%BC): 100] [Mental Health (%BC): 100] [OP ECT Mental Health (%BC): 100] [OP High Cost Drugs (%BC): 100] [Other Outpatient Implant (%BC): 100] [Hyperbarics (%BC): 100] [IV Therapy (%BC): 100] [Pulmonary Function (%BC): 100] [Pulmonary Rehabilitation (%BC): 100] [Trauma (%BC): 100] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health Network","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":533.16,"10th_percentile":412.71,"90th_percentile":13078.5,"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":"Mountain Health Co-Op","plan_name":"Peak Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":599.84,"10th_percentile":476.56,"90th_percentile":819.72},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Minor Procedures","code_information":[{"code":"5732","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Focus","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Options","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":267.2,"10th_percentile":267.2,"90th_percentile":267.2,"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":"Bcbs Mt","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 95] [Observation (%BC): 95] [Emergency Department (%BC): 95] [Cardiac Rehabilitation Therapy (%BC): 95] [Cardiac Stress Test (%BC): 95] [Cardiology (%BC): 95] [Echocardiology (%BC): 95] [EKG/ECG  (%BC): 95] [Electrophysiology (%BC): 95] [Electrophysiologic Ablation (%BC): 95] [Electrophysiology and Mapping Studies (%BC): 95] [Holter Monitor/Telemetry (%BC): 95] [Other Cardiac Testing (%BC): 95] [Peripheral Vascular Lab (%BC): 95] [EEG (%BC): 95] [EMG (%BC): 95] [MEG (%BC): 95] [Neuropsychological Testing and Biofeedback (%BC): 95] [Sleep Studies (%BC): 95] [Chemotherapy (%BC): 95] [Gamma Knife (%BC): 95] [Nuclear Medicine (%BC): 95] [Oncology (%BC): 95] [Radiation Therapy  (%BC): 95] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 95] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 95] [Occupational Therapy (%BC): 95] [Physical Therapy (%BC): 95] [Respiratory Services/Therapy  (%BC): 95] [Speech Therapy (%BC): 95] [Mental Health (%BC): 95] [OP ECT Mental Health (%BC): 95] [OP High Cost Drugs (%BC): 95] [Other Outpatient Implant (%BC): 95] [Hyperbarics (%BC): 95] [IV Therapy (%BC): 95] [Pulmonary Function (%BC): 95] [Pulmonary Rehabilitation (%BC): 95] [Trauma (%BC): 95] [All Other OP (%BC): 95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 100] [Observation (%BC): 100] [Emergency Department (%BC): 100] [Cardiac Rehabilitation Therapy (%BC): 100] [Cardiac Stress Test (%BC): 100] [Cardiology (%BC): 100] [Echocardiology (%BC): 100] [EKG/ECG  (%BC): 100] [Electrophysiology (%BC): 100] [Electrophysiologic Ablation (%BC): 100] [Electrophysiology and Mapping Studies (%BC): 100] [Holter Monitor/Telemetry (%BC): 100] [Other Cardiac Testing (%BC): 100] [Peripheral Vascular Lab (%BC): 100] [EEG (%BC): 100] [EMG (%BC): 100] [MEG (%BC): 100] [Neuropsychological Testing and Biofeedback (%BC): 100] [Sleep Studies (%BC): 100] [Chemotherapy (%BC): 100] [Gamma Knife (%BC): 100] [Nuclear Medicine (%BC): 100] [Oncology (%BC): 100] [Radiation Therapy  (%BC): 100] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 100] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 100] [Occupational Therapy (%BC): 100] [Physical Therapy (%BC): 100] [Respiratory Services/Therapy  (%BC): 100] [Speech Therapy (%BC): 100] [Mental Health (%BC): 100] [OP ECT Mental Health (%BC): 100] [OP High Cost Drugs (%BC): 100] [Other Outpatient Implant (%BC): 100] [Hyperbarics (%BC): 100] [IV Therapy (%BC): 100] [Pulmonary Function (%BC): 100] [Pulmonary Rehabilitation (%BC): 100] [Trauma (%BC): 100] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health Network","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":244.01,"10th_percentile":244.01,"90th_percentile":244.01,"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":"Peak 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"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":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"1 through 10","median_amount":541.5,"10th_percentile":541.5,"90th_percentile":541.5},{"payer_name":"Bcbs Mt","plan_name":"Blue Focus","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":207.1,"10th_percentile":165.68,"90th_percentile":992.75},{"payer_name":"Bcbs Mt","plan_name":"Blue Options","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":255.2,"10th_percentile":148.24,"90th_percentile":617.44,"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":"Bcbs Mt","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 95] [Observation (%BC): 95] [Emergency Department (%BC): 95] [Cardiac Rehabilitation Therapy (%BC): 95] [Cardiac Stress Test (%BC): 95] [Cardiology (%BC): 95] [Echocardiology (%BC): 95] [EKG/ECG  (%BC): 95] [Electrophysiology (%BC): 95] [Electrophysiologic Ablation (%BC): 95] [Electrophysiology and Mapping Studies (%BC): 95] [Holter Monitor/Telemetry (%BC): 95] [Other Cardiac Testing (%BC): 95] [Peripheral Vascular Lab (%BC): 95] [EEG (%BC): 95] [EMG (%BC): 95] [MEG (%BC): 95] [Neuropsychological Testing and Biofeedback (%BC): 95] [Sleep Studies (%BC): 95] [Chemotherapy (%BC): 95] [Gamma Knife (%BC): 95] [Nuclear Medicine (%BC): 95] [Oncology (%BC): 95] [Radiation Therapy  (%BC): 95] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 95] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 95] [Occupational Therapy (%BC): 95] [Physical Therapy (%BC): 95] [Respiratory Services/Therapy  (%BC): 95] [Speech Therapy (%BC): 95] [Mental Health (%BC): 95] [OP ECT Mental Health (%BC): 95] [OP High Cost Drugs (%BC): 95] [Other Outpatient Implant (%BC): 95] [Hyperbarics (%BC): 95] [IV Therapy (%BC): 95] [Pulmonary Function (%BC): 95] [Pulmonary Rehabilitation (%BC): 95] [Trauma (%BC): 95] [All Other OP (%BC): 95]","count":"1 through 10","median_amount":14.98,"10th_percentile":13.49,"90th_percentile":92.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs Mt","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 100] [Observation (%BC): 100] [Emergency Department (%BC): 100] [Cardiac Rehabilitation Therapy (%BC): 100] [Cardiac Stress Test (%BC): 100] [Cardiology (%BC): 100] [Echocardiology (%BC): 100] [EKG/ECG  (%BC): 100] [Electrophysiology (%BC): 100] [Electrophysiologic Ablation (%BC): 100] [Electrophysiology and Mapping Studies (%BC): 100] [Holter Monitor/Telemetry (%BC): 100] [Other Cardiac Testing (%BC): 100] [Peripheral Vascular Lab (%BC): 100] [EEG (%BC): 100] [EMG (%BC): 100] [MEG (%BC): 100] [Neuropsychological Testing and Biofeedback (%BC): 100] [Sleep Studies (%BC): 100] [Chemotherapy (%BC): 100] [Gamma Knife (%BC): 100] [Nuclear Medicine (%BC): 100] [Oncology (%BC): 100] [Radiation Therapy  (%BC): 100] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 100] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 100] [Occupational Therapy (%BC): 100] [Physical Therapy (%BC): 100] [Respiratory Services/Therapy  (%BC): 100] [Speech Therapy (%BC): 100] [Mental Health (%BC): 100] [OP ECT Mental Health (%BC): 100] [OP High Cost Drugs (%BC): 100] [Other Outpatient Implant (%BC): 100] [Hyperbarics (%BC): 100] [IV Therapy (%BC): 100] [Pulmonary Function (%BC): 100] [Pulmonary Rehabilitation (%BC): 100] [Trauma (%BC): 100] [All Other OP (%BC): 100]","count":"1 through 10","median_amount":215.4,"10th_percentile":215.4,"90th_percentile":215.4,"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 Network","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"40","median_amount":244.01,"10th_percentile":110.79,"90th_percentile":451.79,"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":"Peak 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"1 through 10","median_amount":421.47,"10th_percentile":421.47,"90th_percentile":421.47},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":1011.75,"10th_percentile":1011.75,"90th_percentile":1011.75}]}]},{"description":"Level 4 Minor Procedures","code_information":[{"code":"5734","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Focus","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":1139.93,"10th_percentile":1139.93,"90th_percentile":1139.93},{"payer_name":"Bcbs Mt","plan_name":"Blue Options","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":145.64,"10th_percentile":145.64,"90th_percentile":229.28,"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":"Bcbs Mt","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 95] [Observation (%BC): 95] [Emergency Department (%BC): 95] [Cardiac Rehabilitation Therapy (%BC): 95] [Cardiac Stress Test (%BC): 95] [Cardiology (%BC): 95] [Echocardiology (%BC): 95] [EKG/ECG  (%BC): 95] [Electrophysiology (%BC): 95] [Electrophysiologic Ablation (%BC): 95] [Electrophysiology and Mapping Studies (%BC): 95] [Holter Monitor/Telemetry (%BC): 95] [Other Cardiac Testing (%BC): 95] [Peripheral Vascular Lab (%BC): 95] [EEG (%BC): 95] [EMG (%BC): 95] [MEG (%BC): 95] [Neuropsychological Testing and Biofeedback (%BC): 95] [Sleep Studies (%BC): 95] [Chemotherapy (%BC): 95] [Gamma Knife (%BC): 95] [Nuclear Medicine (%BC): 95] [Oncology (%BC): 95] [Radiation Therapy  (%BC): 95] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 95] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 95] [Occupational Therapy (%BC): 95] [Physical Therapy (%BC): 95] [Respiratory Services/Therapy  (%BC): 95] [Speech Therapy (%BC): 95] [Mental Health (%BC): 95] [OP ECT Mental Health (%BC): 95] [OP High Cost Drugs (%BC): 95] [Other Outpatient Implant (%BC): 95] [Hyperbarics (%BC): 95] [IV Therapy (%BC): 95] [Pulmonary Function (%BC): 95] [Pulmonary Rehabilitation (%BC): 95] [Trauma (%BC): 95] [All Other OP (%BC): 95]","count":"1 through 10","median_amount":284.05,"10th_percentile":177.65,"90th_percentile":564.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs Mt","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 100] [Observation (%BC): 100] [Emergency Department (%BC): 100] [Cardiac Rehabilitation Therapy (%BC): 100] [Cardiac Stress Test (%BC): 100] [Cardiology (%BC): 100] [Echocardiology (%BC): 100] [EKG/ECG  (%BC): 100] [Electrophysiology (%BC): 100] [Electrophysiologic Ablation (%BC): 100] [Electrophysiology and Mapping Studies (%BC): 100] [Holter Monitor/Telemetry (%BC): 100] [Other Cardiac Testing (%BC): 100] [Peripheral Vascular Lab (%BC): 100] [EEG (%BC): 100] [EMG (%BC): 100] [MEG (%BC): 100] [Neuropsychological Testing and Biofeedback (%BC): 100] [Sleep Studies (%BC): 100] [Chemotherapy (%BC): 100] [Gamma Knife (%BC): 100] [Nuclear Medicine (%BC): 100] [Oncology (%BC): 100] [Radiation Therapy  (%BC): 100] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 100] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 100] [Occupational Therapy (%BC): 100] [Physical Therapy (%BC): 100] [Respiratory Services/Therapy  (%BC): 100] [Speech Therapy (%BC): 100] [Mental Health (%BC): 100] [OP ECT Mental Health (%BC): 100] [OP High Cost Drugs (%BC): 100] [Other Outpatient Implant (%BC): 100] [Hyperbarics (%BC): 100] [IV Therapy (%BC): 100] [Pulmonary Function (%BC): 100] [Pulmonary Rehabilitation (%BC): 100] [Trauma (%BC): 100] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health Network","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"24","median_amount":244.21,"10th_percentile":103.69,"90th_percentile":319.76,"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":"Peak Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":846.4,"10th_percentile":846.4,"90th_percentile":846.4},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":931.0,"10th_percentile":931.0,"90th_percentile":931.0}]}]},{"description":"Level 1 Electronic Analysis of Devices","code_information":[{"code":"5741","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Focus","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Options","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 95] [Observation (%BC): 95] [Emergency Department (%BC): 95] [Cardiac Rehabilitation Therapy (%BC): 95] [Cardiac Stress Test (%BC): 95] [Cardiology (%BC): 95] [Echocardiology (%BC): 95] [EKG/ECG  (%BC): 95] [Electrophysiology (%BC): 95] [Electrophysiologic Ablation (%BC): 95] [Electrophysiology and Mapping Studies (%BC): 95] [Holter Monitor/Telemetry (%BC): 95] [Other Cardiac Testing (%BC): 95] [Peripheral Vascular Lab (%BC): 95] [EEG (%BC): 95] [EMG (%BC): 95] [MEG (%BC): 95] [Neuropsychological Testing and Biofeedback (%BC): 95] [Sleep Studies (%BC): 95] [Chemotherapy (%BC): 95] [Gamma Knife (%BC): 95] [Nuclear Medicine (%BC): 95] [Oncology (%BC): 95] [Radiation Therapy  (%BC): 95] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 95] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 95] [Occupational Therapy (%BC): 95] [Physical Therapy (%BC): 95] [Respiratory Services/Therapy  (%BC): 95] [Speech Therapy (%BC): 95] [Mental Health (%BC): 95] [OP ECT Mental Health (%BC): 95] [OP High Cost Drugs (%BC): 95] [Other Outpatient Implant (%BC): 95] [Hyperbarics (%BC): 95] [IV Therapy (%BC): 95] [Pulmonary Function (%BC): 95] [Pulmonary Rehabilitation (%BC): 95] [Trauma (%BC): 95] [All Other OP (%BC): 95]","count":"1 through 10","median_amount":5.92,"10th_percentile":5.92,"90th_percentile":5.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs Mt","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 100] [Observation (%BC): 100] [Emergency Department (%BC): 100] [Cardiac Rehabilitation Therapy (%BC): 100] [Cardiac Stress Test (%BC): 100] [Cardiology (%BC): 100] [Echocardiology (%BC): 100] [EKG/ECG  (%BC): 100] [Electrophysiology (%BC): 100] [Electrophysiologic Ablation (%BC): 100] [Electrophysiology and Mapping Studies (%BC): 100] [Holter Monitor/Telemetry (%BC): 100] [Other Cardiac Testing (%BC): 100] [Peripheral Vascular Lab (%BC): 100] [EEG (%BC): 100] [EMG (%BC): 100] [MEG (%BC): 100] [Neuropsychological Testing and Biofeedback (%BC): 100] [Sleep Studies (%BC): 100] [Chemotherapy (%BC): 100] [Gamma Knife (%BC): 100] [Nuclear Medicine (%BC): 100] [Oncology (%BC): 100] [Radiation Therapy  (%BC): 100] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 100] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 100] [Occupational Therapy (%BC): 100] [Physical Therapy (%BC): 100] [Respiratory Services/Therapy  (%BC): 100] [Speech Therapy (%BC): 100] [Mental Health (%BC): 100] [OP ECT Mental Health (%BC): 100] [OP High Cost Drugs (%BC): 100] [Other Outpatient Implant (%BC): 100] [Hyperbarics (%BC): 100] [IV Therapy (%BC): 100] [Pulmonary Function (%BC): 100] [Pulmonary Rehabilitation (%BC): 100] [Trauma (%BC): 100] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health Network","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Mountain Health Co-Op","plan_name":"Peak 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Rehabilitation","code_information":[{"code":"5771","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"1 through 10","median_amount":1447.8,"10th_percentile":482.6,"90th_percentile":1930.4},{"payer_name":"Bcbs Mt","plan_name":"Blue Focus","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Options","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":1727.2,"10th_percentile":1727.2,"90th_percentile":1727.2,"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":"Bcbs Mt","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 95] [Observation (%BC): 95] [Emergency Department (%BC): 95] [Cardiac Rehabilitation Therapy (%BC): 95] [Cardiac Stress Test (%BC): 95] [Cardiology (%BC): 95] [Echocardiology (%BC): 95] [EKG/ECG  (%BC): 95] [Electrophysiology (%BC): 95] [Electrophysiologic Ablation (%BC): 95] [Electrophysiology and Mapping Studies (%BC): 95] [Holter Monitor/Telemetry (%BC): 95] [Other Cardiac Testing (%BC): 95] [Peripheral Vascular Lab (%BC): 95] [EEG (%BC): 95] [EMG (%BC): 95] [MEG (%BC): 95] [Neuropsychological Testing and Biofeedback (%BC): 95] [Sleep Studies (%BC): 95] [Chemotherapy (%BC): 95] [Gamma Knife (%BC): 95] [Nuclear Medicine (%BC): 95] [Oncology (%BC): 95] [Radiation Therapy  (%BC): 95] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 95] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 95] [Occupational Therapy (%BC): 95] [Physical Therapy (%BC): 95] [Respiratory Services/Therapy  (%BC): 95] [Speech Therapy (%BC): 95] [Mental Health (%BC): 95] [OP ECT Mental Health (%BC): 95] [OP High Cost Drugs (%BC): 95] [Other Outpatient Implant (%BC): 95] [Hyperbarics (%BC): 95] [IV Therapy (%BC): 95] [Pulmonary Function (%BC): 95] [Pulmonary Rehabilitation (%BC): 95] [Trauma (%BC): 95] [All Other OP (%BC): 95]","count":"1 through 10","median_amount":1447.8,"10th_percentile":1447.8,"90th_percentile":1689.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs Mt","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 100] [Observation (%BC): 100] [Emergency Department (%BC): 100] [Cardiac Rehabilitation Therapy (%BC): 100] [Cardiac Stress Test (%BC): 100] [Cardiology (%BC): 100] [Echocardiology (%BC): 100] [EKG/ECG  (%BC): 100] [Electrophysiology (%BC): 100] [Electrophysiologic Ablation (%BC): 100] [Electrophysiology and Mapping Studies (%BC): 100] [Holter Monitor/Telemetry (%BC): 100] [Other Cardiac Testing (%BC): 100] [Peripheral Vascular Lab (%BC): 100] [EEG (%BC): 100] [EMG (%BC): 100] [MEG (%BC): 100] [Neuropsychological Testing and Biofeedback (%BC): 100] [Sleep Studies (%BC): 100] [Chemotherapy (%BC): 100] [Gamma Knife (%BC): 100] [Nuclear Medicine (%BC): 100] [Oncology (%BC): 100] [Radiation Therapy  (%BC): 100] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 100] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 100] [Occupational Therapy (%BC): 100] [Physical Therapy (%BC): 100] [Respiratory Services/Therapy  (%BC): 100] [Speech Therapy (%BC): 100] [Mental Health (%BC): 100] [OP ECT Mental Health (%BC): 100] [OP High Cost Drugs (%BC): 100] [Other Outpatient Implant (%BC): 100] [Hyperbarics (%BC): 100] [IV Therapy (%BC): 100] [Pulmonary Function (%BC): 100] [Pulmonary Rehabilitation (%BC): 100] [Trauma (%BC): 100] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health Network","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"22","median_amount":502.14,"10th_percentile":167.38,"90th_percentile":1673.19,"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":"Peak 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Treatment","code_information":[{"code":"5791","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Focus","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Options","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 95] [Observation (%BC): 95] [Emergency Department (%BC): 95] [Cardiac Rehabilitation Therapy (%BC): 95] [Cardiac Stress Test (%BC): 95] [Cardiology (%BC): 95] [Echocardiology (%BC): 95] [EKG/ECG  (%BC): 95] [Electrophysiology (%BC): 95] [Electrophysiologic Ablation (%BC): 95] [Electrophysiology and Mapping Studies (%BC): 95] [Holter Monitor/Telemetry (%BC): 95] [Other Cardiac Testing (%BC): 95] [Peripheral Vascular Lab (%BC): 95] [EEG (%BC): 95] [EMG (%BC): 95] [MEG (%BC): 95] [Neuropsychological Testing and Biofeedback (%BC): 95] [Sleep Studies (%BC): 95] [Chemotherapy (%BC): 95] [Gamma Knife (%BC): 95] [Nuclear Medicine (%BC): 95] [Oncology (%BC): 95] [Radiation Therapy  (%BC): 95] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 95] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 95] [Occupational Therapy (%BC): 95] [Physical Therapy (%BC): 95] [Respiratory Services/Therapy  (%BC): 95] [Speech Therapy (%BC): 95] [Mental Health (%BC): 95] [OP ECT Mental Health (%BC): 95] [OP High Cost Drugs (%BC): 95] [Other Outpatient Implant (%BC): 95] [Hyperbarics (%BC): 95] [IV Therapy (%BC): 95] [Pulmonary Function (%BC): 95] [Pulmonary Rehabilitation (%BC): 95] [Trauma (%BC): 95] [All Other OP (%BC): 95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 100] [Observation (%BC): 100] [Emergency Department (%BC): 100] [Cardiac Rehabilitation Therapy (%BC): 100] [Cardiac Stress Test (%BC): 100] [Cardiology (%BC): 100] [Echocardiology (%BC): 100] [EKG/ECG  (%BC): 100] [Electrophysiology (%BC): 100] [Electrophysiologic Ablation (%BC): 100] [Electrophysiology and Mapping Studies (%BC): 100] [Holter Monitor/Telemetry (%BC): 100] [Other Cardiac Testing (%BC): 100] [Peripheral Vascular Lab (%BC): 100] [EEG (%BC): 100] [EMG (%BC): 100] [MEG (%BC): 100] [Neuropsychological Testing and Biofeedback (%BC): 100] [Sleep Studies (%BC): 100] [Chemotherapy (%BC): 100] [Gamma Knife (%BC): 100] [Nuclear Medicine (%BC): 100] [Oncology (%BC): 100] [Radiation Therapy  (%BC): 100] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 100] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 100] [Occupational Therapy (%BC): 100] [Physical Therapy (%BC): 100] [Respiratory Services/Therapy  (%BC): 100] [Speech Therapy (%BC): 100] [Mental Health (%BC): 100] [OP ECT Mental Health (%BC): 100] [OP High Cost Drugs (%BC): 100] [Other Outpatient Implant (%BC): 100] [Hyperbarics (%BC): 100] [IV Therapy (%BC): 100] [Pulmonary Function (%BC): 100] [Pulmonary Rehabilitation (%BC): 100] [Trauma (%BC): 100] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health Network","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":244.01,"10th_percentile":244.01,"90th_percentile":244.01,"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":"Peak 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"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":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Focus","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Options","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":271.8,"10th_percentile":271.8,"90th_percentile":271.8,"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":"Bcbs Mt","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 95] [Observation (%BC): 95] [Emergency Department (%BC): 95] [Cardiac Rehabilitation Therapy (%BC): 95] [Cardiac Stress Test (%BC): 95] [Cardiology (%BC): 95] [Echocardiology (%BC): 95] [EKG/ECG  (%BC): 95] [Electrophysiology (%BC): 95] [Electrophysiologic Ablation (%BC): 95] [Electrophysiology and Mapping Studies (%BC): 95] [Holter Monitor/Telemetry (%BC): 95] [Other Cardiac Testing (%BC): 95] [Peripheral Vascular Lab (%BC): 95] [EEG (%BC): 95] [EMG (%BC): 95] [MEG (%BC): 95] [Neuropsychological Testing and Biofeedback (%BC): 95] [Sleep Studies (%BC): 95] [Chemotherapy (%BC): 95] [Gamma Knife (%BC): 95] [Nuclear Medicine (%BC): 95] [Oncology (%BC): 95] [Radiation Therapy  (%BC): 95] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 95] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 95] [Occupational Therapy (%BC): 95] [Physical Therapy (%BC): 95] [Respiratory Services/Therapy  (%BC): 95] [Speech Therapy (%BC): 95] [Mental Health (%BC): 95] [OP ECT Mental Health (%BC): 95] [OP High Cost Drugs (%BC): 95] [Other Outpatient Implant (%BC): 95] [Hyperbarics (%BC): 95] [IV Therapy (%BC): 95] [Pulmonary Function (%BC): 95] [Pulmonary Rehabilitation (%BC): 95] [Trauma (%BC): 95] [All Other OP (%BC): 95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 100] [Observation (%BC): 100] [Emergency Department (%BC): 100] [Cardiac Rehabilitation Therapy (%BC): 100] [Cardiac Stress Test (%BC): 100] [Cardiology (%BC): 100] [Echocardiology (%BC): 100] [EKG/ECG  (%BC): 100] [Electrophysiology (%BC): 100] [Electrophysiologic Ablation (%BC): 100] [Electrophysiology and Mapping Studies (%BC): 100] [Holter Monitor/Telemetry (%BC): 100] [Other Cardiac Testing (%BC): 100] [Peripheral Vascular Lab (%BC): 100] [EEG (%BC): 100] [EMG (%BC): 100] [MEG (%BC): 100] [Neuropsychological Testing and Biofeedback (%BC): 100] [Sleep Studies (%BC): 100] [Chemotherapy (%BC): 100] [Gamma Knife (%BC): 100] [Nuclear Medicine (%BC): 100] [Oncology (%BC): 100] [Radiation Therapy  (%BC): 100] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 100] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 100] [Occupational Therapy (%BC): 100] [Physical Therapy (%BC): 100] [Respiratory Services/Therapy  (%BC): 100] [Speech Therapy (%BC): 100] [Mental Health (%BC): 100] [OP ECT Mental Health (%BC): 100] [OP High Cost Drugs (%BC): 100] [Other Outpatient Implant (%BC): 100] [Hyperbarics (%BC): 100] [IV Therapy (%BC): 100] [Pulmonary Function (%BC): 100] [Pulmonary Rehabilitation (%BC): 100] [Trauma (%BC): 100] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health Network","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":244.01,"10th_percentile":244.01,"90th_percentile":244.01,"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":"Peak 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"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":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Focus","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Options","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":312.6,"10th_percentile":251.0,"90th_percentile":371.8,"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":"Bcbs Mt","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 95] [Observation (%BC): 95] [Emergency Department (%BC): 95] [Cardiac Rehabilitation Therapy (%BC): 95] [Cardiac Stress Test (%BC): 95] [Cardiology (%BC): 95] [Echocardiology (%BC): 95] [EKG/ECG  (%BC): 95] [Electrophysiology (%BC): 95] [Electrophysiologic Ablation (%BC): 95] [Electrophysiology and Mapping Studies (%BC): 95] [Holter Monitor/Telemetry (%BC): 95] [Other Cardiac Testing (%BC): 95] [Peripheral Vascular Lab (%BC): 95] [EEG (%BC): 95] [EMG (%BC): 95] [MEG (%BC): 95] [Neuropsychological Testing and Biofeedback (%BC): 95] [Sleep Studies (%BC): 95] [Chemotherapy (%BC): 95] [Gamma Knife (%BC): 95] [Nuclear Medicine (%BC): 95] [Oncology (%BC): 95] [Radiation Therapy  (%BC): 95] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 95] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 95] [Occupational Therapy (%BC): 95] [Physical Therapy (%BC): 95] [Respiratory Services/Therapy  (%BC): 95] [Speech Therapy (%BC): 95] [Mental Health (%BC): 95] [OP ECT Mental Health (%BC): 95] [OP High Cost Drugs (%BC): 95] [Other Outpatient Implant (%BC): 95] [Hyperbarics (%BC): 95] [IV Therapy (%BC): 95] [Pulmonary Function (%BC): 95] [Pulmonary Rehabilitation (%BC): 95] [Trauma (%BC): 95] [All Other OP (%BC): 95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 100] [Observation (%BC): 100] [Emergency Department (%BC): 100] [Cardiac Rehabilitation Therapy (%BC): 100] [Cardiac Stress Test (%BC): 100] [Cardiology (%BC): 100] [Echocardiology (%BC): 100] [EKG/ECG  (%BC): 100] [Electrophysiology (%BC): 100] [Electrophysiologic Ablation (%BC): 100] [Electrophysiology and Mapping Studies (%BC): 100] [Holter Monitor/Telemetry (%BC): 100] [Other Cardiac Testing (%BC): 100] [Peripheral Vascular Lab (%BC): 100] [EEG (%BC): 100] [EMG (%BC): 100] [MEG (%BC): 100] [Neuropsychological Testing and Biofeedback (%BC): 100] [Sleep Studies (%BC): 100] [Chemotherapy (%BC): 100] [Gamma Knife (%BC): 100] [Nuclear Medicine (%BC): 100] [Oncology (%BC): 100] [Radiation Therapy  (%BC): 100] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 100] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 100] [Occupational Therapy (%BC): 100] [Physical Therapy (%BC): 100] [Respiratory Services/Therapy  (%BC): 100] [Speech Therapy (%BC): 100] [Mental Health (%BC): 100] [OP ECT Mental Health (%BC): 100] [OP High Cost Drugs (%BC): 100] [Other Outpatient Implant (%BC): 100] [Hyperbarics (%BC): 100] [IV Therapy (%BC): 100] [Pulmonary Function (%BC): 100] [Pulmonary Rehabilitation (%BC): 100] [Trauma (%BC): 100] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health Network","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"48","median_amount":244.01,"10th_percentile":244.01,"90th_percentile":608.83,"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":"Peak 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"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":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Focus","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Options","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":54.4,"10th_percentile":54.4,"90th_percentile":160.0,"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":"Bcbs Mt","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 95] [Observation (%BC): 95] [Emergency Department (%BC): 95] [Cardiac Rehabilitation Therapy (%BC): 95] [Cardiac Stress Test (%BC): 95] [Cardiology (%BC): 95] [Echocardiology (%BC): 95] [EKG/ECG  (%BC): 95] [Electrophysiology (%BC): 95] [Electrophysiologic Ablation (%BC): 95] [Electrophysiology and Mapping Studies (%BC): 95] [Holter Monitor/Telemetry (%BC): 95] [Other Cardiac Testing (%BC): 95] [Peripheral Vascular Lab (%BC): 95] [EEG (%BC): 95] [EMG (%BC): 95] [MEG (%BC): 95] [Neuropsychological Testing and Biofeedback (%BC): 95] [Sleep Studies (%BC): 95] [Chemotherapy (%BC): 95] [Gamma Knife (%BC): 95] [Nuclear Medicine (%BC): 95] [Oncology (%BC): 95] [Radiation Therapy  (%BC): 95] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 95] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 95] [Occupational Therapy (%BC): 95] [Physical Therapy (%BC): 95] [Respiratory Services/Therapy  (%BC): 95] [Speech Therapy (%BC): 95] [Mental Health (%BC): 95] [OP ECT Mental Health (%BC): 95] [OP High Cost Drugs (%BC): 95] [Other Outpatient Implant (%BC): 95] [Hyperbarics (%BC): 95] [IV Therapy (%BC): 95] [Pulmonary Function (%BC): 95] [Pulmonary Rehabilitation (%BC): 95] [Trauma (%BC): 95] [All Other OP (%BC): 95]","count":"1 through 10","median_amount":76.0,"10th_percentile":76.0,"90th_percentile":152.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs Mt","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 100] [Observation (%BC): 100] [Emergency Department (%BC): 100] [Cardiac Rehabilitation Therapy (%BC): 100] [Cardiac Stress Test (%BC): 100] [Cardiology (%BC): 100] [Echocardiology (%BC): 100] [EKG/ECG  (%BC): 100] [Electrophysiology (%BC): 100] [Electrophysiologic Ablation (%BC): 100] [Electrophysiology and Mapping Studies (%BC): 100] [Holter Monitor/Telemetry (%BC): 100] [Other Cardiac Testing (%BC): 100] [Peripheral Vascular Lab (%BC): 100] [EEG (%BC): 100] [EMG (%BC): 100] [MEG (%BC): 100] [Neuropsychological Testing and Biofeedback (%BC): 100] [Sleep Studies (%BC): 100] [Chemotherapy (%BC): 100] [Gamma Knife (%BC): 100] [Nuclear Medicine (%BC): 100] [Oncology (%BC): 100] [Radiation Therapy  (%BC): 100] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 100] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 100] [Occupational Therapy (%BC): 100] [Physical Therapy (%BC): 100] [Respiratory Services/Therapy  (%BC): 100] [Speech Therapy (%BC): 100] [Mental Health (%BC): 100] [OP ECT Mental Health (%BC): 100] [OP High Cost Drugs (%BC): 100] [Other Outpatient Implant (%BC): 100] [Hyperbarics (%BC): 100] [IV Therapy (%BC): 100] [Pulmonary Function (%BC): 100] [Pulmonary Rehabilitation (%BC): 100] [Trauma (%BC): 100] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health Network","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":52.53,"10th_percentile":52.53,"90th_percentile":105.06,"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":"Peak 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"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":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":57.0,"10th_percentile":57.0,"90th_percentile":57.0,"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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Focus","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":22.16,"10th_percentile":22.16,"90th_percentile":22.16},{"payer_name":"Bcbs Mt","plan_name":"Blue Options","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"95","median_amount":259.4,"10th_percentile":242.2,"90th_percentile":301.02,"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":"Bcbs Mt","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 95] [Observation (%BC): 95] [Emergency Department (%BC): 95] [Cardiac Rehabilitation Therapy (%BC): 95] [Cardiac Stress Test (%BC): 95] [Cardiology (%BC): 95] [Echocardiology (%BC): 95] [EKG/ECG  (%BC): 95] [Electrophysiology (%BC): 95] [Electrophysiologic Ablation (%BC): 95] [Electrophysiology and Mapping Studies (%BC): 95] [Holter Monitor/Telemetry (%BC): 95] [Other Cardiac Testing (%BC): 95] [Peripheral Vascular Lab (%BC): 95] [EEG (%BC): 95] [EMG (%BC): 95] [MEG (%BC): 95] [Neuropsychological Testing and Biofeedback (%BC): 95] [Sleep Studies (%BC): 95] [Chemotherapy (%BC): 95] [Gamma Knife (%BC): 95] [Nuclear Medicine (%BC): 95] [Oncology (%BC): 95] [Radiation Therapy  (%BC): 95] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 95] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 95] [Occupational Therapy (%BC): 95] [Physical Therapy (%BC): 95] [Respiratory Services/Therapy  (%BC): 95] [Speech Therapy (%BC): 95] [Mental Health (%BC): 95] [OP ECT Mental Health (%BC): 95] [OP High Cost Drugs (%BC): 95] [Other Outpatient Implant (%BC): 95] [Hyperbarics (%BC): 95] [IV Therapy (%BC): 95] [Pulmonary Function (%BC): 95] [Pulmonary Rehabilitation (%BC): 95] [Trauma (%BC): 95] [All Other OP (%BC): 95]","count":"1 through 10","median_amount":87.6,"10th_percentile":50.0,"90th_percentile":263.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs Mt","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 100] [Observation (%BC): 100] [Emergency Department (%BC): 100] [Cardiac Rehabilitation Therapy (%BC): 100] [Cardiac Stress Test (%BC): 100] [Cardiology (%BC): 100] [Echocardiology (%BC): 100] [EKG/ECG  (%BC): 100] [Electrophysiology (%BC): 100] [Electrophysiologic Ablation (%BC): 100] [Electrophysiology and Mapping Studies (%BC): 100] [Holter Monitor/Telemetry (%BC): 100] [Other Cardiac Testing (%BC): 100] [Peripheral Vascular Lab (%BC): 100] [EEG (%BC): 100] [EMG (%BC): 100] [MEG (%BC): 100] [Neuropsychological Testing and Biofeedback (%BC): 100] [Sleep Studies (%BC): 100] [Chemotherapy (%BC): 100] [Gamma Knife (%BC): 100] [Nuclear Medicine (%BC): 100] [Oncology (%BC): 100] [Radiation Therapy  (%BC): 100] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 100] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 100] [Occupational Therapy (%BC): 100] [Physical Therapy (%BC): 100] [Respiratory Services/Therapy  (%BC): 100] [Speech Therapy (%BC): 100] [Mental Health (%BC): 100] [OP ECT Mental Health (%BC): 100] [OP High Cost Drugs (%BC): 100] [Other Outpatient Implant (%BC): 100] [Hyperbarics (%BC): 100] [IV Therapy (%BC): 100] [Pulmonary Function (%BC): 100] [Pulmonary Rehabilitation (%BC): 100] [Trauma (%BC): 100] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health Network","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"900","median_amount":244.01,"10th_percentile":193.75,"90th_percentile":244.01,"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":"Peak 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":211.8,"10th_percentile":204.74,"90th_percentile":215.33,"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":"Pacificsource","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":376.85,"10th_percentile":376.85,"90th_percentile":376.85},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":75.0,"10th_percentile":75.0,"90th_percentile":75.0}]}]},{"description":"Clinical Diagnostic Lab Services","code_information":[{"code":"N800","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"22","median_amount":185.27,"10th_percentile":52.38,"90th_percentile":499.55},{"payer_name":"Allegiance","plan_name":"Mmia","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":411.92,"10th_percentile":162.64,"90th_percentile":545.3,"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":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"21","median_amount":21.85,"10th_percentile":21.85,"90th_percentile":236.55},{"payer_name":"Bcbs Mt","plan_name":"Blue Focus","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"122","median_amount":141.65,"10th_percentile":21.85,"90th_percentile":431.3},{"payer_name":"Bcbs Mt","plan_name":"Blue Options","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"54","median_amount":184.04,"10th_percentile":78.2,"90th_percentile":387.36,"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":"Bcbs Mt","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 95] [Observation (%BC): 95] [Emergency Department (%BC): 95] [Cardiac Rehabilitation Therapy (%BC): 95] [Cardiac Stress Test (%BC): 95] [Cardiology (%BC): 95] [Echocardiology (%BC): 95] [EKG/ECG  (%BC): 95] [Electrophysiology (%BC): 95] [Electrophysiologic Ablation (%BC): 95] [Electrophysiology and Mapping Studies (%BC): 95] [Holter Monitor/Telemetry (%BC): 95] [Other Cardiac Testing (%BC): 95] [Peripheral Vascular Lab (%BC): 95] [EEG (%BC): 95] [EMG (%BC): 95] [MEG (%BC): 95] [Neuropsychological Testing and Biofeedback (%BC): 95] [Sleep Studies (%BC): 95] [Chemotherapy (%BC): 95] [Gamma Knife (%BC): 95] [Nuclear Medicine (%BC): 95] [Oncology (%BC): 95] [Radiation Therapy  (%BC): 95] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 95] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 95] [Occupational Therapy (%BC): 95] [Physical Therapy (%BC): 95] [Respiratory Services/Therapy  (%BC): 95] [Speech Therapy (%BC): 95] [Mental Health (%BC): 95] [OP ECT Mental Health (%BC): 95] [OP High Cost Drugs (%BC): 95] [Other Outpatient Implant (%BC): 95] [Hyperbarics (%BC): 95] [IV Therapy (%BC): 95] [Pulmonary Function (%BC): 95] [Pulmonary Rehabilitation (%BC): 95] [Trauma (%BC): 95] [All Other OP (%BC): 95]","count":"281","median_amount":56.22,"10th_percentile":22.42,"90th_percentile":150.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs Mt","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 100] [Observation (%BC): 100] [Emergency Department (%BC): 100] [Cardiac Rehabilitation Therapy (%BC): 100] [Cardiac Stress Test (%BC): 100] [Cardiology (%BC): 100] [Echocardiology (%BC): 100] [EKG/ECG  (%BC): 100] [Electrophysiology (%BC): 100] [Electrophysiologic Ablation (%BC): 100] [Electrophysiology and Mapping Studies (%BC): 100] [Holter Monitor/Telemetry (%BC): 100] [Other Cardiac Testing (%BC): 100] [Peripheral Vascular Lab (%BC): 100] [EEG (%BC): 100] [EMG (%BC): 100] [MEG (%BC): 100] [Neuropsychological Testing and Biofeedback (%BC): 100] [Sleep Studies (%BC): 100] [Chemotherapy (%BC): 100] [Gamma Knife (%BC): 100] [Nuclear Medicine (%BC): 100] [Oncology (%BC): 100] [Radiation Therapy  (%BC): 100] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 100] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 100] [Occupational Therapy (%BC): 100] [Physical Therapy (%BC): 100] [Respiratory Services/Therapy  (%BC): 100] [Speech Therapy (%BC): 100] [Mental Health (%BC): 100] [OP ECT Mental Health (%BC): 100] [OP High Cost Drugs (%BC): 100] [Other Outpatient Implant (%BC): 100] [Hyperbarics (%BC): 100] [IV Therapy (%BC): 100] [Pulmonary Function (%BC): 100] [Pulmonary Rehabilitation (%BC): 100] [Trauma (%BC): 100] [All Other OP (%BC): 100]","count":"1 through 10","median_amount":61.35,"10th_percentile":8.63,"90th_percentile":508.12,"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":"First Choice Health Network","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"1 through 10","median_amount":102.95,"10th_percentile":102.95,"90th_percentile":355.99},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"597","median_amount":110.6,"10th_percentile":15.1,"90th_percentile":355.32,"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":"Mountain Health Co-Op","plan_name":"Peak Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":127.88,"10th_percentile":78.2,"90th_percentile":287.04},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"36","median_amount":210.9,"10th_percentile":51.3,"90th_percentile":463.6},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"56","median_amount":196.08,"10th_percentile":70.3,"90th_percentile":545.3}]}]},{"description":"Therapy Services","code_information":[{"code":"N801","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"1 through 10","median_amount":1202.8,"10th_percentile":601.4,"90th_percentile":2255.25},{"payer_name":"Allegiance","plan_name":"Mmia","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":1178.0,"10th_percentile":1178.0,"90th_percentile":1619.75,"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":"Allegiance","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"11","median_amount":983.43,"10th_percentile":589.0,"90th_percentile":1700.5},{"payer_name":"Bcbs Mt","plan_name":"Blue Focus","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"46","median_amount":532.71,"10th_percentile":152.0,"90th_percentile":1258.75},{"payer_name":"Bcbs Mt","plan_name":"Blue Options","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":530.1,"10th_percentile":530.1,"90th_percentile":530.1},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"31","median_amount":421.6,"10th_percentile":268.6,"90th_percentile":1428.0,"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":"Bcbs Mt","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 95] [Observation (%BC): 95] [Emergency Department (%BC): 95] [Cardiac Rehabilitation Therapy (%BC): 95] [Cardiac Stress Test (%BC): 95] [Cardiology (%BC): 95] [Echocardiology (%BC): 95] [EKG/ECG  (%BC): 95] [Electrophysiology (%BC): 95] [Electrophysiologic Ablation (%BC): 95] [Electrophysiology and Mapping Studies (%BC): 95] [Holter Monitor/Telemetry (%BC): 95] [Other Cardiac Testing (%BC): 95] [Peripheral Vascular Lab (%BC): 95] [EEG (%BC): 95] [EMG (%BC): 95] [MEG (%BC): 95] [Neuropsychological Testing and Biofeedback (%BC): 95] [Sleep Studies (%BC): 95] [Chemotherapy (%BC): 95] [Gamma Knife (%BC): 95] [Nuclear Medicine (%BC): 95] [Oncology (%BC): 95] [Radiation Therapy  (%BC): 95] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 95] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 95] [Occupational Therapy (%BC): 95] [Physical Therapy (%BC): 95] [Respiratory Services/Therapy  (%BC): 95] [Speech Therapy (%BC): 95] [Mental Health (%BC): 95] [OP ECT Mental Health (%BC): 95] [OP High Cost Drugs (%BC): 95] [Other Outpatient Implant (%BC): 95] [Hyperbarics (%BC): 95] [IV Therapy (%BC): 95] [Pulmonary Function (%BC): 95] [Pulmonary Rehabilitation (%BC): 95] [Trauma (%BC): 95] [All Other OP (%BC): 95]","count":"159","median_amount":682.1,"10th_percentile":236.93,"90th_percentile":1767.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs Mt","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 100] [Observation (%BC): 100] [Emergency Department (%BC): 100] [Cardiac Rehabilitation Therapy (%BC): 100] [Cardiac Stress Test (%BC): 100] [Cardiology (%BC): 100] [Echocardiology (%BC): 100] [EKG/ECG  (%BC): 100] [Electrophysiology (%BC): 100] [Electrophysiologic Ablation (%BC): 100] [Electrophysiology and Mapping Studies (%BC): 100] [Holter Monitor/Telemetry (%BC): 100] [Other Cardiac Testing (%BC): 100] [Peripheral Vascular Lab (%BC): 100] [EEG (%BC): 100] [EMG (%BC): 100] [MEG (%BC): 100] [Neuropsychological Testing and Biofeedback (%BC): 100] [Sleep Studies (%BC): 100] [Chemotherapy (%BC): 100] [Gamma Knife (%BC): 100] [Nuclear Medicine (%BC): 100] [Oncology (%BC): 100] [Radiation Therapy  (%BC): 100] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 100] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 100] [Occupational Therapy (%BC): 100] [Physical Therapy (%BC): 100] [Respiratory Services/Therapy  (%BC): 100] [Speech Therapy (%BC): 100] [Mental Health (%BC): 100] [OP ECT Mental Health (%BC): 100] [OP High Cost Drugs (%BC): 100] [Other Outpatient Implant (%BC): 100] [Hyperbarics (%BC): 100] [IV Therapy (%BC): 100] [Pulmonary Function (%BC): 100] [Pulmonary Rehabilitation (%BC): 100] [Trauma (%BC): 100] [All Other OP (%BC): 100]","count":"1 through 10","median_amount":375.25,"10th_percentile":375.25,"90th_percentile":1432.0,"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 Network","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"206","median_amount":467.93,"10th_percentile":199.45,"90th_percentile":1281.6,"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":"Peak Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":1996.4,"10th_percentile":1838.79,"90th_percentile":2012.04},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"21","median_amount":589.0,"10th_percentile":203.84,"90th_percentile":1116.0},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"47","median_amount":964.25,"10th_percentile":342.0,"90th_percentile":2223.75}]}]},{"description":"Mammography Services","code_information":[{"code":"N804","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"1 through 10","median_amount":284.21,"10th_percentile":284.21,"90th_percentile":284.21},{"payer_name":"Allegiance","plan_name":"Mmia","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"1 through 10","median_amount":278.35,"10th_percentile":278.35,"90th_percentile":278.35},{"payer_name":"Bcbs Mt","plan_name":"Blue Focus","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"27","median_amount":278.35,"10th_percentile":278.35,"90th_percentile":278.35},{"payer_name":"Bcbs Mt","plan_name":"Blue Options","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":271.7,"10th_percentile":269.81,"90th_percentile":273.03,"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":"Bcbs Mt","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 95] [Observation (%BC): 95] [Emergency Department (%BC): 95] [Cardiac Rehabilitation Therapy (%BC): 95] [Cardiac Stress Test (%BC): 95] [Cardiology (%BC): 95] [Echocardiology (%BC): 95] [EKG/ECG  (%BC): 95] [Electrophysiology (%BC): 95] [Electrophysiologic Ablation (%BC): 95] [Electrophysiology and Mapping Studies (%BC): 95] [Holter Monitor/Telemetry (%BC): 95] [Other Cardiac Testing (%BC): 95] [Peripheral Vascular Lab (%BC): 95] [EEG (%BC): 95] [EMG (%BC): 95] [MEG (%BC): 95] [Neuropsychological Testing and Biofeedback (%BC): 95] [Sleep Studies (%BC): 95] [Chemotherapy (%BC): 95] [Gamma Knife (%BC): 95] [Nuclear Medicine (%BC): 95] [Oncology (%BC): 95] [Radiation Therapy  (%BC): 95] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 95] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 95] [Occupational Therapy (%BC): 95] [Physical Therapy (%BC): 95] [Respiratory Services/Therapy  (%BC): 95] [Speech Therapy (%BC): 95] [Mental Health (%BC): 95] [OP ECT Mental Health (%BC): 95] [OP High Cost Drugs (%BC): 95] [Other Outpatient Implant (%BC): 95] [Hyperbarics (%BC): 95] [IV Therapy (%BC): 95] [Pulmonary Function (%BC): 95] [Pulmonary Rehabilitation (%BC): 95] [Trauma (%BC): 95] [All Other OP (%BC): 95]","count":"43","median_amount":275.27,"10th_percentile":275.27,"90th_percentile":275.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs Mt","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 100] [Observation (%BC): 100] [Emergency Department (%BC): 100] [Cardiac Rehabilitation Therapy (%BC): 100] [Cardiac Stress Test (%BC): 100] [Cardiology (%BC): 100] [Echocardiology (%BC): 100] [EKG/ECG  (%BC): 100] [Electrophysiology (%BC): 100] [Electrophysiologic Ablation (%BC): 100] [Electrophysiology and Mapping Studies (%BC): 100] [Holter Monitor/Telemetry (%BC): 100] [Other Cardiac Testing (%BC): 100] [Peripheral Vascular Lab (%BC): 100] [EEG (%BC): 100] [EMG (%BC): 100] [MEG (%BC): 100] [Neuropsychological Testing and Biofeedback (%BC): 100] [Sleep Studies (%BC): 100] [Chemotherapy (%BC): 100] [Gamma Knife (%BC): 100] [Nuclear Medicine (%BC): 100] [Oncology (%BC): 100] [Radiation Therapy  (%BC): 100] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 100] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 100] [Occupational Therapy (%BC): 100] [Physical Therapy (%BC): 100] [Respiratory Services/Therapy  (%BC): 100] [Speech Therapy (%BC): 100] [Mental Health (%BC): 100] [OP ECT Mental Health (%BC): 100] [OP High Cost Drugs (%BC): 100] [Other Outpatient Implant (%BC): 100] [Hyperbarics (%BC): 100] [IV Therapy (%BC): 100] [Pulmonary Function (%BC): 100] [Pulmonary Rehabilitation (%BC): 100] [Trauma (%BC): 100] [All Other OP (%BC): 100]","count":"1 through 10","median_amount":275.27,"10th_percentile":275.27,"90th_percentile":275.27,"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 Network","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"1 through 10","median_amount":284.21,"10th_percentile":284.21,"90th_percentile":284.21},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"54","median_amount":262.69,"10th_percentile":262.69,"90th_percentile":263.98,"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":"Peak Ppo","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":269.56,"10th_percentile":269.56,"90th_percentile":269.56},{"payer_name":"Pacificsource","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"1 through 10","median_amount":278.35,"10th_percentile":278.35,"90th_percentile":285.91},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"11","median_amount":278.35,"10th_percentile":278.35,"90th_percentile":278.35}]}]},{"description":"Other Medicine","code_information":[{"code":"N809","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Focus","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Options","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 95] [Observation (%BC): 95] [Emergency Department (%BC): 95] [Cardiac Rehabilitation Therapy (%BC): 95] [Cardiac Stress Test (%BC): 95] [Cardiology (%BC): 95] [Echocardiology (%BC): 95] [EKG/ECG  (%BC): 95] [Electrophysiology (%BC): 95] [Electrophysiologic Ablation (%BC): 95] [Electrophysiology and Mapping Studies (%BC): 95] [Holter Monitor/Telemetry (%BC): 95] [Other Cardiac Testing (%BC): 95] [Peripheral Vascular Lab (%BC): 95] [EEG (%BC): 95] [EMG (%BC): 95] [MEG (%BC): 95] [Neuropsychological Testing and Biofeedback (%BC): 95] [Sleep Studies (%BC): 95] [Chemotherapy (%BC): 95] [Gamma Knife (%BC): 95] [Nuclear Medicine (%BC): 95] [Oncology (%BC): 95] [Radiation Therapy  (%BC): 95] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 95] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 95] [Occupational Therapy (%BC): 95] [Physical Therapy (%BC): 95] [Respiratory Services/Therapy  (%BC): 95] [Speech Therapy (%BC): 95] [Mental Health (%BC): 95] [OP ECT Mental Health (%BC): 95] [OP High Cost Drugs (%BC): 95] [Other Outpatient Implant (%BC): 95] [Hyperbarics (%BC): 95] [IV Therapy (%BC): 95] [Pulmonary Function (%BC): 95] [Pulmonary Rehabilitation (%BC): 95] [Trauma (%BC): 95] [All Other OP (%BC): 95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 100] [Observation (%BC): 100] [Emergency Department (%BC): 100] [Cardiac Rehabilitation Therapy (%BC): 100] [Cardiac Stress Test (%BC): 100] [Cardiology (%BC): 100] [Echocardiology (%BC): 100] [EKG/ECG  (%BC): 100] [Electrophysiology (%BC): 100] [Electrophysiologic Ablation (%BC): 100] [Electrophysiology and Mapping Studies (%BC): 100] [Holter Monitor/Telemetry (%BC): 100] [Other Cardiac Testing (%BC): 100] [Peripheral Vascular Lab (%BC): 100] [EEG (%BC): 100] [EMG (%BC): 100] [MEG (%BC): 100] [Neuropsychological Testing and Biofeedback (%BC): 100] [Sleep Studies (%BC): 100] [Chemotherapy (%BC): 100] [Gamma Knife (%BC): 100] [Nuclear Medicine (%BC): 100] [Oncology (%BC): 100] [Radiation Therapy  (%BC): 100] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 100] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 100] [Occupational Therapy (%BC): 100] [Physical Therapy (%BC): 100] [Respiratory Services/Therapy  (%BC): 100] [Speech Therapy (%BC): 100] [Mental Health (%BC): 100] [OP ECT Mental Health (%BC): 100] [OP High Cost Drugs (%BC): 100] [Other Outpatient Implant (%BC): 100] [Hyperbarics (%BC): 100] [IV Therapy (%BC): 100] [Pulmonary Function (%BC): 100] [Pulmonary Rehabilitation (%BC): 100] [Trauma (%BC): 100] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health Network","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":244.01,"10th_percentile":244.01,"90th_percentile":244.01,"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":"Peak 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-covered Services","code_information":[{"code":"N900","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Focus","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":499.7,"10th_percentile":499.7,"90th_percentile":499.7},{"payer_name":"Bcbs Mt","plan_name":"Blue Options","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":263.0,"10th_percentile":259.4,"90th_percentile":307.8,"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":"Bcbs Mt","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 95] [Observation (%BC): 95] [Emergency Department (%BC): 95] [Cardiac Rehabilitation Therapy (%BC): 95] [Cardiac Stress Test (%BC): 95] [Cardiology (%BC): 95] [Echocardiology (%BC): 95] [EKG/ECG  (%BC): 95] [Electrophysiology (%BC): 95] [Electrophysiologic Ablation (%BC): 95] [Electrophysiology and Mapping Studies (%BC): 95] [Holter Monitor/Telemetry (%BC): 95] [Other Cardiac Testing (%BC): 95] [Peripheral Vascular Lab (%BC): 95] [EEG (%BC): 95] [EMG (%BC): 95] [MEG (%BC): 95] [Neuropsychological Testing and Biofeedback (%BC): 95] [Sleep Studies (%BC): 95] [Chemotherapy (%BC): 95] [Gamma Knife (%BC): 95] [Nuclear Medicine (%BC): 95] [Oncology (%BC): 95] [Radiation Therapy  (%BC): 95] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 95] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 95] [Occupational Therapy (%BC): 95] [Physical Therapy (%BC): 95] [Respiratory Services/Therapy  (%BC): 95] [Speech Therapy (%BC): 95] [Mental Health (%BC): 95] [OP ECT Mental Health (%BC): 95] [OP High Cost Drugs (%BC): 95] [Other Outpatient Implant (%BC): 95] [Hyperbarics (%BC): 95] [IV Therapy (%BC): 95] [Pulmonary Function (%BC): 95] [Pulmonary Rehabilitation (%BC): 95] [Trauma (%BC): 95] [All Other OP (%BC): 95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 100] [Observation (%BC): 100] [Emergency Department (%BC): 100] [Cardiac Rehabilitation Therapy (%BC): 100] [Cardiac Stress Test (%BC): 100] [Cardiology (%BC): 100] [Echocardiology (%BC): 100] [EKG/ECG  (%BC): 100] [Electrophysiology (%BC): 100] [Electrophysiologic Ablation (%BC): 100] [Electrophysiology and Mapping Studies (%BC): 100] [Holter Monitor/Telemetry (%BC): 100] [Other Cardiac Testing (%BC): 100] [Peripheral Vascular Lab (%BC): 100] [EEG (%BC): 100] [EMG (%BC): 100] [MEG (%BC): 100] [Neuropsychological Testing and Biofeedback (%BC): 100] [Sleep Studies (%BC): 100] [Chemotherapy (%BC): 100] [Gamma Knife (%BC): 100] [Nuclear Medicine (%BC): 100] [Oncology (%BC): 100] [Radiation Therapy  (%BC): 100] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 100] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 100] [Occupational Therapy (%BC): 100] [Physical Therapy (%BC): 100] [Respiratory Services/Therapy  (%BC): 100] [Speech Therapy (%BC): 100] [Mental Health (%BC): 100] [OP ECT Mental Health (%BC): 100] [OP High Cost Drugs (%BC): 100] [Other Outpatient Implant (%BC): 100] [Hyperbarics (%BC): 100] [IV Therapy (%BC): 100] [Pulmonary Function (%BC): 100] [Pulmonary Rehabilitation (%BC): 100] [Trauma (%BC): 100] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health Network","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"54","median_amount":244.01,"10th_percentile":244.01,"90th_percentile":244.01,"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":"Peak 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Not Recognized by OPPS","code_information":[{"code":"N905","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Mmia","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Focus","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Blue Options","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 95] [Observation (%BC): 95] [Emergency Department (%BC): 95] [Cardiac Rehabilitation Therapy (%BC): 95] [Cardiac Stress Test (%BC): 95] [Cardiology (%BC): 95] [Echocardiology (%BC): 95] [EKG/ECG  (%BC): 95] [Electrophysiology (%BC): 95] [Electrophysiologic Ablation (%BC): 95] [Electrophysiology and Mapping Studies (%BC): 95] [Holter Monitor/Telemetry (%BC): 95] [Other Cardiac Testing (%BC): 95] [Peripheral Vascular Lab (%BC): 95] [EEG (%BC): 95] [EMG (%BC): 95] [MEG (%BC): 95] [Neuropsychological Testing and Biofeedback (%BC): 95] [Sleep Studies (%BC): 95] [Chemotherapy (%BC): 95] [Gamma Knife (%BC): 95] [Nuclear Medicine (%BC): 95] [Oncology (%BC): 95] [Radiation Therapy  (%BC): 95] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 95] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 95] [Occupational Therapy (%BC): 95] [Physical Therapy (%BC): 95] [Respiratory Services/Therapy  (%BC): 95] [Speech Therapy (%BC): 95] [Mental Health (%BC): 95] [OP ECT Mental Health (%BC): 95] [OP High Cost Drugs (%BC): 95] [Other Outpatient Implant (%BC): 95] [Hyperbarics (%BC): 95] [IV Therapy (%BC): 95] [Pulmonary Function (%BC): 95] [Pulmonary Rehabilitation (%BC): 95] [Trauma (%BC): 95] [All Other OP (%BC): 95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Mt","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 100] [Observation (%BC): 100] [Emergency Department (%BC): 100] [Cardiac Rehabilitation Therapy (%BC): 100] [Cardiac Stress Test (%BC): 100] [Cardiology (%BC): 100] [Echocardiology (%BC): 100] [EKG/ECG  (%BC): 100] [Electrophysiology (%BC): 100] [Electrophysiologic Ablation (%BC): 100] [Electrophysiology and Mapping Studies (%BC): 100] [Holter Monitor/Telemetry (%BC): 100] [Other Cardiac Testing (%BC): 100] [Peripheral Vascular Lab (%BC): 100] [EEG (%BC): 100] [EMG (%BC): 100] [MEG (%BC): 100] [Neuropsychological Testing and Biofeedback (%BC): 100] [Sleep Studies (%BC): 100] [Chemotherapy (%BC): 100] [Gamma Knife (%BC): 100] [Nuclear Medicine (%BC): 100] [Oncology (%BC): 100] [Radiation Therapy  (%BC): 100] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Reference Lab Fee Schedule: Fee Schedule] [Hemodialysis (%BC): 100] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 100] [Occupational Therapy (%BC): 100] [Physical Therapy (%BC): 100] [Respiratory Services/Therapy  (%BC): 100] [Speech Therapy (%BC): 100] [Mental Health (%BC): 100] [OP ECT Mental Health (%BC): 100] [OP High Cost Drugs (%BC): 100] [Other Outpatient Implant (%BC): 100] [Hyperbarics (%BC): 100] [IV Therapy (%BC): 100] [Pulmonary Function (%BC): 100] [Pulmonary Rehabilitation (%BC): 100] [Trauma (%BC): 100] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Choice Health Network","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":97.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"83","median_amount":244.01,"10th_percentile":244.01,"90th_percentile":244.59,"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":"Peak 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","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":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]}]}