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logic."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":1120.20,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1680.30,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1680.30,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":1213.55,"methodology":"percent of total 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rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":12145.60,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":9109.20,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":13663.80,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus 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charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":65.70,"standard_charge_algorithm":"Reimbursement will be 65.7% of billable gross charges.","estimated_amount":9974.57,"methodology":"percent of total billed charges"}]}]},{"description":"ENDCAP SPN 15MM 12MM ","code_information":[{"code":"90694","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":10803.00,"discounted_cash":10803.00,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":79.10,"standard_charge_algorithm":"Reimbursement will be 79.1% of billable gross charges.","estimated_amount":8545.17,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":10262.85,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":4267.19,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QEP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":10262.85,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QHP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":10262.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":58.00,"standard_charge_algorithm":"Reimbursement will be 58% of billable gross charges.","estimated_amount":6265.74,"methodology":"percent of total billed charges"},{"payer_name":"Corizon 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charges"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":8642.40,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":8642.40,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":6481.80,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":9722.70,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":9722.70,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":7021.95,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"QHP","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":7021.95,"methodology":"percent of total billed charges"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":4267.19,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":65.70,"standard_charge_algorithm":"Reimbursement will be 65.7% of billable gross charges.","estimated_amount":7097.57,"methodology":"percent of total billed charges"}]}]},{"description":"ENDCAP SPN 7D 17X14MM ","code_information":[{"code":"87159","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":10803.00,"discounted_cash":10803.00,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":79.10,"standard_charge_algorithm":"Reimbursement will be 79.1% of billable gross charges.","estimated_amount":8545.17,"methodology":"percent of total billed charges"},{"payer_name":"Blue 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charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":58.00,"standard_charge_algorithm":"Reimbursement will be 58% of billable gross charges.","estimated_amount":6265.74,"methodology":"percent of total billed charges"},{"payer_name":"Corizon Health","plan_name":"LOCALGOV","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":3997.11,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":9722.70,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":9722.70,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":8642.40,"methodology":"percent of total billed charges"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":9182.55,"methodology":"percent of total billed charges"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_percentage":72.30,"standard_charge_algorithm":"Reimbursement will be 72.3% of billable gross charges.","estimated_amount":7810.57,"methodology":"percent of total billed charges"},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":64.70,"standard_charge_algorithm":"Reimbursement will be 64.7% of billable gross charges.","estimated_amount":6989.54,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":4893.76,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":8642.40,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":8642.40,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":6481.80,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":9722.70,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":9722.70,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":7021.95,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"QHP","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":7021.95,"methodology":"percent of total billed charges"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":4267.19,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":65.70,"standard_charge_algorithm":"Reimbursement will be 65.7% of billable gross charges.","estimated_amount":7097.57,"methodology":"percent of total billed charges"}]}]},{"description":"ENDOCRINE DISORDERS WITH MCC ","code_information":[{"code":"643","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":750.00,"maximum":35709.38,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":80.90,"standard_charge_algorithm":"Reimbursement will be 80.9% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_dollar":12244.72,"methodology":"fee schedule"},{"payer_name":"Blue Cross","plan_name":"POS","standard_charge_dollar":34311.85,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"PPO","standard_charge_dollar":34311.85,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"QEP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QHP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"TRAD","standard_charge_dollar":34311.85,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Business Psychology Associates","plan_name":"COMM","standard_charge_dollar":750.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":60.10,"standard_charge_algorithm":"Reimbursement will be 60.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Corizon Health","plan_name":"LOCALGOV","standard_charge_dollar":15585.40,"methodology":"fee schedule"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"EverNorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_dollar":13605.24,"methodology":"fee schedule"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRHMO","standard_charge_dollar":13605.24,"methodology":"fee schedule"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRPPO","standard_charge_dollar":13605.24,"methodology":"fee schedule"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_dollar":26877.64,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $76870.06, reimbursement will be 61.2% of billable gross charges instead of the contracted rate."},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":66.10,"standard_charge_algorithm":"Reimbursement will be 66.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":13605.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":62.00,"standard_charge_algorithm":"Reimbursement will be 62% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_dollar":35709.38,"methodology":"fee schedule"},{"payer_name":"St Luke's Health Partners","plan_name":"QHP","standard_charge_dollar":18738.18,"methodology":"fee schedule"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_dollar":12244.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":15825.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $199902.00, reimbursement will be $9841 per diem instead of the contracted rate."},{"payer_name":"United  ","plan_name":"MGMCR","standard_charge_dollar":12924.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":69.00,"standard_charge_algorithm":"Reimbursement will be 69% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veteran's Administration","plan_name":"FEDERAL","standard_charge_dollar":13605.24,"methodology":"fee schedule"}]}]},{"description":"ENDPLATE SPN INF 3D ","code_information":[{"code":"332686","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":38836.00,"discounted_cash":38836.00,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":79.10,"standard_charge_algorithm":"Reimbursement will be 79.1% of billable gross 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charges.","estimated_amount":34952.40,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":31068.80,"methodology":"percent of total billed charges"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":33010.60,"methodology":"percent of total billed charges"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_percentage":72.30,"standard_charge_algorithm":"Reimbursement will be 72.3% of billable gross charges.","estimated_amount":28078.43,"methodology":"percent of total billed charges"},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":64.70,"standard_charge_algorithm":"Reimbursement will be 64.7% of billable gross 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dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":23301.60,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":34952.40,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":34952.40,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross 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","drug_information":{"unit":"150","type":"ME"},"code_information":[{"code":"642281","type":"CDM"},{"code":"J1650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":787.27,"discounted_cash":787.27,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":79.10,"standard_charge_algorithm":"Reimbursement will be 79.1% of billable gross charges.","estimated_amount":622.73,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":747.91,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":310.97,"methodology":"percent of total billed charges"},{"payer_name":"Blue 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charges"},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":64.70,"standard_charge_algorithm":"Reimbursement will be 64.7% of billable gross charges.","estimated_amount":509.36,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":356.63,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":629.82,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":629.82,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":472.36,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":708.54,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":708.54,"methodology":"percent of total billed charges"},{"payer_name":"True 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charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":58.00,"standard_charge_algorithm":"Reimbursement will be 58% of billable gross charges.","estimated_amount":5409.66,"methodology":"percent of total billed charges"},{"payer_name":"Corizon Health","plan_name":"LOCALGOV","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":3450.99,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":8394.30,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":8394.30,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":7461.60,"methodology":"percent of total billed charges"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":7927.95,"methodology":"percent of total billed charges"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_percentage":72.30,"standard_charge_algorithm":"Reimbursement will be 72.3% of billable gross charges.","estimated_amount":6743.42,"methodology":"percent of total billed charges"},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":64.70,"standard_charge_algorithm":"Reimbursement will be 64.7% of billable gross charges.","estimated_amount":6034.57,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":4225.13,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":7461.60,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":7461.60,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":5596.20,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":8394.30,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":8394.30,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":6062.55,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"QHP","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":6062.55,"methodology":"percent of total billed charges"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":3684.16,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":65.70,"standard_charge_algorithm":"Reimbursement will be 65.7% of billable gross charges.","estimated_amount":6127.84,"methodology":"percent of total billed charges"}]}]},{"description":"EP W/LA REC W/ARRHYTHMIA ","code_information":[{"code":"45243","type":"CDM"},{"code":"93621","type":"CPT"}],"standard_charges":[{"setting":"outpatient","gross_charge":15547.03,"discounted_cash":15547.03,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":79.10,"standard_charge_algorithm":"Reimbursement will be 79.1% of billable gross charges.","estimated_amount":12297.70,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":14769.68,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":6141.08,"methodology":"percent of total billed charges"},{"payer_name":"Blue 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(in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":6258.40,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":4693.80,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":7040.70,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus 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charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1276.37,"methodology":"percent of total billed charges"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1356.14,"methodology":"percent of total billed charges"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_percentage":72.30,"standard_charge_algorithm":"Reimbursement will be 72.3% of billable gross charges.","estimated_amount":1153.52,"methodology":"percent of total billed charges"},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":64.70,"standard_charge_algorithm":"Reimbursement will be 64.7% of billable gross charges.","estimated_amount":1032.26,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":722.74,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1276.37,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1276.37,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":957.28,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1435.91,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1435.91,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":1037.05,"methodology":"percent of total 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","code_information":[{"code":"91952","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":9106.00,"discounted_cash":9106.00,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":79.10,"standard_charge_algorithm":"Reimbursement will be 79.1% of billable gross charges.","estimated_amount":7202.85,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":8650.70,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":3596.87,"methodology":"percent of total billed charges"},{"payer_name":"Blue 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charges"},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":64.70,"standard_charge_algorithm":"Reimbursement will be 64.7% of billable gross charges.","estimated_amount":5891.58,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":4125.02,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":7284.80,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":7284.80,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":5463.60,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":8195.40,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":8195.40,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health 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charges"}]}]},{"description":"EXTRAOCULAR PROCEDURES EXCEPT ORBIT ","code_information":[{"code":"115","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":750.00,"maximum":33002.45,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":80.90,"standard_charge_algorithm":"Reimbursement will be 80.9% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_dollar":11404.67,"methodology":"fee schedule"},{"payer_name":"Blue Cross","plan_name":"POS","standard_charge_dollar":32628.69,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"PPO","standard_charge_dollar":32628.69,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"QEP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QHP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"TRAD","standard_charge_dollar":32628.69,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Business Psychology Associates","plan_name":"COMM","standard_charge_dollar":750.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":60.10,"standard_charge_algorithm":"Reimbursement will be 60.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Corizon Health","plan_name":"LOCALGOV","standard_charge_dollar":14396.72,"methodology":"fee schedule"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"EverNorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_dollar":12671.85,"methodology":"fee schedule"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRHMO","standard_charge_dollar":12671.85,"methodology":"fee schedule"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRPPO","standard_charge_dollar":12671.85,"methodology":"fee schedule"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_dollar":24571.01,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $70273.09, reimbursement will be 61.2% of billable gross charges instead of the contracted rate."},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":66.10,"standard_charge_algorithm":"Reimbursement will be 66.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":12671.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":62.00,"standard_charge_algorithm":"Reimbursement will be 62% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_dollar":33002.45,"methodology":"fee schedule"},{"payer_name":"St Luke's Health Partners","plan_name":"QHP","standard_charge_dollar":17317.74,"methodology":"fee schedule"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_dollar":11404.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":27836.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $199902.00, reimbursement will be $9841 per diem instead of the contracted rate."},{"payer_name":"United  ","plan_name":"MGMCR","standard_charge_dollar":12038.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":69.00,"standard_charge_algorithm":"Reimbursement will be 69% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veteran's Administration","plan_name":"FEDERAL","standard_charge_dollar":12671.85,"methodology":"fee schedule"}]}]},{"description":"EYE SPHERE ORBT HA 20MM ","code_information":[{"code":"83971","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":5159.00,"discounted_cash":5159.00,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":79.10,"standard_charge_algorithm":"Reimbursement will be 79.1% of billable gross charges.","estimated_amount":4080.77,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":4901.05,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":2037.81,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QEP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":4901.05,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QHP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":4901.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":58.00,"standard_charge_algorithm":"Reimbursement will be 58% of billable gross charges.","estimated_amount":2992.22,"methodology":"percent of total billed charges"},{"payer_name":"Corizon Health","plan_name":"LOCALGOV","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":1908.83,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":4643.10,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":4643.10,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":4127.20,"methodology":"percent of total billed charges"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":4385.15,"methodology":"percent of total billed charges"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_percentage":72.30,"standard_charge_algorithm":"Reimbursement will be 72.3% of billable gross charges.","estimated_amount":3729.96,"methodology":"percent of total billed charges"},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":64.70,"standard_charge_algorithm":"Reimbursement will be 64.7% of billable gross charges.","estimated_amount":3337.87,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":2337.03,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":4127.20,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":4127.20,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":3095.40,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":4643.10,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":4643.10,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":3353.35,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"QHP","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":3353.35,"methodology":"percent of total billed charges"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":2037.81,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":65.70,"standard_charge_algorithm":"Reimbursement will be 65.7% of billable gross charges.","estimated_amount":3389.46,"methodology":"percent of total billed charges"}]}]},{"description":"FACTOR 8 VW AG ","code_information":[{"code":"85246","type":"CPT"},{"code":"852466","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":898.81,"discounted_cash":898.81,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":79.10,"standard_charge_algorithm":"Reimbursement will be 79.1% of billable gross charges.","estimated_amount":710.96,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":853.87,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":355.03,"methodology":"percent of total billed charges"},{"payer_name":"Blue 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Cross","plan_name":"TRAD","standard_charge_percentage":55.90,"standard_charge_algorithm":"Reimbursement will be 55.9% of billable gross charges.","estimated_amount":502.43,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":58.00,"standard_charge_algorithm":"Reimbursement will be 58% of billable gross charges.","estimated_amount":521.31,"methodology":"percent of total billed charges"},{"payer_name":"Corizon Health","plan_name":"LOCALGOV","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":332.56,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":808.93,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":808.93,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":719.05,"methodology":"percent of total billed charges"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":763.99,"methodology":"percent of total billed charges"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_percentage":72.30,"standard_charge_algorithm":"Reimbursement will be 72.3% of billable gross charges.","estimated_amount":649.84,"methodology":"percent of total billed charges"},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":64.70,"standard_charge_algorithm":"Reimbursement will be 64.7% of billable gross charges.","estimated_amount":581.53,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":407.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":719.05,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":719.05,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":539.29,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":808.93,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":808.93,"methodology":"percent of total billed charges"},{"payer_name":"True 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Cross","plan_name":"QEP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":42.79,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QHP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":42.79,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"TRAD","standard_charge_percentage":55.90,"standard_charge_algorithm":"Reimbursement will be 55.9% of billable gross charges.","estimated_amount":25.18,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":58.00,"standard_charge_algorithm":"Reimbursement will be 58% of billable gross charges.","estimated_amount":26.12,"methodology":"percent of total billed charges"},{"payer_name":"Corizon Health","plan_name":"LOCALGOV","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":16.66,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":40.54,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":40.54,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":36.03,"methodology":"percent of total billed charges"},{"payer_name":"GEHA PPO 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charges"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":36.03,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":36.03,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":27.02,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":40.54,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":40.54,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":29.28,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"QHP","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":29.28,"methodology":"percent of total billed charges"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":17.79,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":65.70,"standard_charge_algorithm":"Reimbursement will be 65.7% of billable gross charges.","estimated_amount":29.59,"methodology":"percent of total billed charges"}]}]},{"description":"FE FUM/C/B12-IF-FA PO ","code_information":[{"code":"644525","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":34.61,"discounted_cash":34.61,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":79.10,"standard_charge_algorithm":"Reimbursement will be 79.1% of billable gross charges.","estimated_amount":27.38,"methodology":"percent of total billed charges"},{"payer_name":"Blue 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Health","plan_name":"LOCALGOV","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":12.81,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":31.15,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":31.15,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":27.69,"methodology":"percent of total billed charges"},{"payer_name":"GEHA PPO 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billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"PPO","standard_charge_dollar":29302.00,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"QEP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QHP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"TRAD","standard_charge_dollar":29302.00,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Business Psychology Associates","plan_name":"COMM","standard_charge_dollar":750.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":60.10,"standard_charge_algorithm":"Reimbursement will be 60.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Corizon Health","plan_name":"LOCALGOV","standard_charge_dollar":12810.25,"methodology":"fee schedule"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"EverNorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_dollar":11426.12,"methodology":"fee schedule"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRHMO","standard_charge_dollar":11426.12,"methodology":"fee schedule"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRPPO","standard_charge_dollar":11426.12,"methodology":"fee schedule"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_dollar":21854.31,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $62503.33, reimbursement will be 61.2% of billable gross charges instead of the contracted rate."},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":66.10,"standard_charge_algorithm":"Reimbursement will be 66.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":11426.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":62.00,"standard_charge_algorithm":"Reimbursement will be 62% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_dollar":30788.67,"methodology":"fee schedule"},{"payer_name":"St Luke's Health Partners","plan_name":"QHP","standard_charge_dollar":16156.08,"methodology":"fee schedule"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_dollar":10283.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":13449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. 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(in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":9380.80,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":7035.60,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":10553.40,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus 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charges"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":7193.60,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":7193.60,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":5395.20,"methodology":"percent of total billed 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total billed charges"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":2254.66,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":65.70,"standard_charge_algorithm":"Reimbursement will be 65.7% of billable gross charges.","estimated_amount":3750.16,"methodology":"percent of total billed charges"}]}]},{"description":"HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC ","code_information":[{"code":"001","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":750.00,"maximum":611474.02,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":80.90,"standard_charge_algorithm":"Reimbursement will be 80.9% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed 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If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"PPO","standard_charge_dollar":565195.50,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. 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logic."},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":16.78,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":12.58,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":18.87,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will 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charges.","estimated_amount":264.01,"methodology":"percent of total billed charges"}]}]},{"description":"HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC ","code_information":[{"code":"420","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":750.00,"maximum":70849.57,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":80.90,"standard_charge_algorithm":"Reimbursement will be 80.9% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_dollar":24685.19,"methodology":"fee schedule"},{"payer_name":"Blue 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If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"PPO","standard_charge_dollar":66759.09,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"QEP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QHP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"TRAD","standard_charge_dollar":66759.09,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Business Psychology Associates","plan_name":"COMM","standard_charge_dollar":750.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":60.10,"standard_charge_algorithm":"Reimbursement will be 60.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Corizon Health","plan_name":"LOCALGOV","standard_charge_dollar":33188.91,"methodology":"fee schedule"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"EverNorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_dollar":27427.99,"methodology":"fee schedule"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRHMO","standard_charge_dollar":27427.99,"methodology":"fee schedule"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRPPO","standard_charge_dollar":27427.99,"methodology":"fee schedule"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_dollar":56794.42,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $162432.04, reimbursement will be 61.2% of billable gross charges instead of the contracted rate."},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":66.10,"standard_charge_algorithm":"Reimbursement will be 66.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":27427.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":62.00,"standard_charge_algorithm":"Reimbursement will be 62% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_dollar":70849.57,"methodology":"fee schedule"},{"payer_name":"St Luke's Health Partners","plan_name":"QHP","standard_charge_dollar":37177.68,"methodology":"fee schedule"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_dollar":24685.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":27836.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $199902.00, reimbursement will be $9841 per diem instead of the contracted rate."},{"payer_name":"United  ","plan_name":"MGMCR","standard_charge_dollar":26056.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":69.00,"standard_charge_algorithm":"Reimbursement will be 69% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veteran's Administration","plan_name":"FEDERAL","standard_charge_dollar":27427.99,"methodology":"fee schedule"}]}]},{"description":"HERPES 6 AMP PROBE ","code_information":[{"code":"46279","type":"CDM"},{"code":"87532","type":"CPT"}],"standard_charges":[{"setting":"outpatient","gross_charge":143.00,"discounted_cash":143.00,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":79.10,"standard_charge_algorithm":"Reimbursement will be 79.1% of billable gross 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logic."},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":311.58,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":233.69,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":350.53,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement 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be 65.7% of billable gross charges.","estimated_amount":255.89,"methodology":"percent of total billed charges"}]}]},{"description":"HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC ","code_information":[{"code":"482","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":750.00,"maximum":35761.52,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":80.90,"standard_charge_algorithm":"Reimbursement will be 80.9% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_dollar":11773.52,"methodology":"fee schedule"},{"payer_name":"Blue 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If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"PPO","standard_charge_dollar":33129.26,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"QEP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QHP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"TRAD","standard_charge_dollar":33129.26,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. 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","code_information":[{"code":"641738","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":365.63,"discounted_cash":365.63,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":79.10,"standard_charge_algorithm":"Reimbursement will be 79.1% of billable gross charges.","estimated_amount":289.21,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":347.35,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":144.42,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"POS","standard_charge_percentage":55.90,"standard_charge_algorithm":"Reimbursement will be 55.9% of billable gross charges.","estimated_amount":204.39,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"PPO","standard_charge_percentage":55.90,"standard_charge_algorithm":"Reimbursement will be 55.9% of billable gross charges.","estimated_amount":204.39,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QEP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":347.35,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QHP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":347.35,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"TRAD","standard_charge_percentage":55.90,"standard_charge_algorithm":"Reimbursement will be 55.9% of billable gross charges.","estimated_amount":204.39,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":58.00,"standard_charge_algorithm":"Reimbursement will be 58% of billable gross charges.","estimated_amount":212.07,"methodology":"percent of total billed charges"},{"payer_name":"Corizon Health","plan_name":"LOCALGOV","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":135.28,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":329.07,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":329.07,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":292.50,"methodology":"percent of total billed charges"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":310.79,"methodology":"percent of total billed charges"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_percentage":72.30,"standard_charge_algorithm":"Reimbursement will be 72.3% of billable gross charges.","estimated_amount":264.35,"methodology":"percent of total billed charges"},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":64.70,"standard_charge_algorithm":"Reimbursement will be 64.7% of billable gross charges.","estimated_amount":236.56,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":165.63,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":292.50,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":292.50,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":219.38,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":329.07,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":329.07,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":237.66,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"QHP","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":237.66,"methodology":"percent of total billed charges"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":144.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":65.70,"standard_charge_algorithm":"Reimbursement will be 65.7% of billable gross charges.","estimated_amount":240.22,"methodology":"percent of total billed charges"}]}]},{"description":"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC ","code_information":[{"code":"759","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":750.00,"maximum":15825.00,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":80.90,"standard_charge_algorithm":"Reimbursement will be 80.9% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_dollar":5483.16,"methodology":"fee schedule"},{"payer_name":"Blue Cross","plan_name":"POS","standard_charge_dollar":13477.79,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"PPO","standard_charge_dollar":13477.79,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"QEP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QHP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"TRAD","standard_charge_dollar":13477.79,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Business Psychology Associates","plan_name":"COMM","standard_charge_dollar":750.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":60.10,"standard_charge_algorithm":"Reimbursement will be 60.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Corizon Health","plan_name":"LOCALGOV","standard_charge_dollar":6017.68,"methodology":"fee schedule"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"EverNorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_dollar":6092.40,"methodology":"fee schedule"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRHMO","standard_charge_dollar":6092.40,"methodology":"fee schedule"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRPPO","standard_charge_dollar":6092.40,"methodology":"fee schedule"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_dollar":10918.06,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $31225.65, reimbursement will be 61.2% of billable gross charges instead of the contracted rate."},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":66.10,"standard_charge_algorithm":"Reimbursement will be 66.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":6092.40,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":62.00,"standard_charge_algorithm":"Reimbursement will be 62% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_dollar":13478.19,"methodology":"fee schedule"},{"payer_name":"St Luke's Health Partners","plan_name":"QHP","standard_charge_dollar":7072.56,"methodology":"fee schedule"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_dollar":5483.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":15825.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $199902.00, reimbursement will be $9841 per diem instead of the contracted rate."},{"payer_name":"United  ","plan_name":"MGMCR","standard_charge_dollar":5787.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":69.00,"standard_charge_algorithm":"Reimbursement will be 69% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veteran's Administration","plan_name":"FEDERAL","standard_charge_dollar":6092.40,"methodology":"fee schedule"}]}]},{"description":"INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC ","code_information":[{"code":"387","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":750.00,"maximum":15825.00,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":80.90,"standard_charge_algorithm":"Reimbursement will be 80.9% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_dollar":5685.20,"methodology":"fee schedule"},{"payer_name":"Blue Cross","plan_name":"POS","standard_charge_dollar":14268.27,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"PPO","standard_charge_dollar":14268.27,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"QEP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QHP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"TRAD","standard_charge_dollar":14268.27,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Business Psychology Associates","plan_name":"COMM","standard_charge_dollar":750.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":60.10,"standard_charge_algorithm":"Reimbursement will be 60.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Corizon Health","plan_name":"LOCALGOV","standard_charge_dollar":6303.56,"methodology":"fee schedule"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"EverNorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_dollar":6316.89,"methodology":"fee schedule"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRHMO","standard_charge_dollar":6316.89,"methodology":"fee schedule"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRPPO","standard_charge_dollar":6316.89,"methodology":"fee schedule"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_dollar":11586.07,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $33136.17, reimbursement will be 61.2% of billable gross charges instead of the contracted rate."},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":66.10,"standard_charge_algorithm":"Reimbursement will be 66.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":6316.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":62.00,"standard_charge_algorithm":"Reimbursement will be 62% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_dollar":15025.01,"methodology":"fee schedule"},{"payer_name":"St Luke's Health Partners","plan_name":"QHP","standard_charge_dollar":7884.24,"methodology":"fee schedule"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_dollar":5685.20,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":15825.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $199902.00, reimbursement will be $9841 per diem instead of the contracted rate."},{"payer_name":"United  ","plan_name":"MGMCR","standard_charge_dollar":6001.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":69.00,"standard_charge_algorithm":"Reimbursement will be 69% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veteran's Administration","plan_name":"FEDERAL","standard_charge_dollar":6316.89,"methodology":"fee schedule"}]}]},{"description":"INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC ","code_information":[{"code":"351","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":750.00,"maximum":31940.09,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":80.90,"standard_charge_algorithm":"Reimbursement will be 80.9% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_dollar":11230.54,"methodology":"fee schedule"},{"payer_name":"Blue Cross","plan_name":"POS","standard_charge_dollar":30359.45,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"PPO","standard_charge_dollar":30359.45,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"QEP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QHP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"TRAD","standard_charge_dollar":30359.45,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Business Psychology Associates","plan_name":"COMM","standard_charge_dollar":750.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":60.10,"standard_charge_algorithm":"Reimbursement will be 60.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Corizon Health","plan_name":"LOCALGOV","standard_charge_dollar":14150.33,"methodology":"fee schedule"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"EverNorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_dollar":12478.38,"methodology":"fee schedule"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRHMO","standard_charge_dollar":12478.38,"methodology":"fee schedule"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRPPO","standard_charge_dollar":12478.38,"methodology":"fee schedule"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_dollar":24112.99,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $68963.15, reimbursement will be 61.2% of billable gross charges instead of the contracted rate."},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":66.10,"standard_charge_algorithm":"Reimbursement will be 66.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":12478.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":62.00,"standard_charge_algorithm":"Reimbursement will be 62% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_dollar":31940.09,"methodology":"fee schedule"},{"payer_name":"St Luke's Health Partners","plan_name":"QHP","standard_charge_dollar":16760.28,"methodology":"fee schedule"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_dollar":11230.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":27836.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $199902.00, reimbursement will be $9841 per diem instead of the contracted rate."},{"payer_name":"United  ","plan_name":"MGMCR","standard_charge_dollar":11854.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":69.00,"standard_charge_algorithm":"Reimbursement will be 69% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veteran's Administration","plan_name":"FEDERAL","standard_charge_dollar":12478.38,"methodology":"fee schedule"}]}]},{"description":"INH DORNASE ALFA UD 1 MG ","drug_information":{"unit":"1","type":"ME"},"code_information":[{"code":"642170","type":"CDM"},{"code":"J7639","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":167.99,"discounted_cash":167.99,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":79.10,"standard_charge_algorithm":"Reimbursement will be 79.1% of billable gross charges.","estimated_amount":132.88,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":159.59,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":66.36,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"POS","standard_charge_percentage":55.90,"standard_charge_algorithm":"Reimbursement will be 55.9% of billable gross charges.","estimated_amount":93.91,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"PPO","standard_charge_percentage":55.90,"standard_charge_algorithm":"Reimbursement will be 55.9% of billable gross charges.","estimated_amount":93.91,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QEP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":159.59,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QHP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":159.59,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"TRAD","standard_charge_percentage":55.90,"standard_charge_algorithm":"Reimbursement will be 55.9% of billable gross charges.","estimated_amount":93.91,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":58.00,"standard_charge_algorithm":"Reimbursement will be 58% of billable gross charges.","estimated_amount":97.43,"methodology":"percent of total billed charges"},{"payer_name":"Corizon Health","plan_name":"LOCALGOV","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":62.16,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":151.19,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":151.19,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":134.39,"methodology":"percent of total billed charges"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":142.79,"methodology":"percent of total billed charges"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_percentage":72.30,"standard_charge_algorithm":"Reimbursement will be 72.3% of billable gross charges.","estimated_amount":121.46,"methodology":"percent of total billed charges"},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":64.70,"standard_charge_algorithm":"Reimbursement will be 64.7% of billable gross charges.","estimated_amount":108.69,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":76.10,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":134.39,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":134.39,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":100.79,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":151.19,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":151.19,"methodology":"percent of total billed charges"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":66.36,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":65.70,"standard_charge_algorithm":"Reimbursement will be 65.7% of billable gross charges.","estimated_amount":110.37,"methodology":"percent of total billed charges"}]}]},{"description":"INH METHACHOLINE 100 MG ","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"648492","type":"CDM"},{"code":"J7674","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":318.06,"discounted_cash":318.06,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":79.10,"standard_charge_algorithm":"Reimbursement will be 79.1% of billable gross charges.","estimated_amount":251.59,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":302.16,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":125.63,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"POS","standard_charge_percentage":55.90,"standard_charge_algorithm":"Reimbursement will be 55.9% of billable gross charges.","estimated_amount":177.80,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"PPO","standard_charge_percentage":55.90,"standard_charge_algorithm":"Reimbursement will be 55.9% of billable gross charges.","estimated_amount":177.80,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QEP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":302.16,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QHP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":302.16,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"TRAD","standard_charge_percentage":55.90,"standard_charge_algorithm":"Reimbursement will be 55.9% of billable gross charges.","estimated_amount":177.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":58.00,"standard_charge_algorithm":"Reimbursement will be 58% of billable gross charges.","estimated_amount":184.47,"methodology":"percent of total billed charges"},{"payer_name":"Corizon Health","plan_name":"LOCALGOV","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":117.68,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":286.25,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":286.25,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":254.45,"methodology":"percent of total billed charges"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":270.35,"methodology":"percent of total billed charges"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_percentage":72.30,"standard_charge_algorithm":"Reimbursement will be 72.3% of billable gross charges.","estimated_amount":229.96,"methodology":"percent of total billed charges"},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":64.70,"standard_charge_algorithm":"Reimbursement will be 64.7% of billable gross charges.","estimated_amount":205.78,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":144.08,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":254.45,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":254.45,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":190.84,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":286.25,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":286.25,"methodology":"percent of total billed charges"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":125.63,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":65.70,"standard_charge_algorithm":"Reimbursement will be 65.7% of billable gross charges.","estimated_amount":208.97,"methodology":"percent of total billed charges"}]}]},{"description":"INI-1 AB IHC ","code_information":[{"code":"45770","type":"CDM"},{"code":"88342","type":"CPT"}],"standard_charges":[{"setting":"outpatient","gross_charge":389.48,"discounted_cash":389.48,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":79.10,"standard_charge_algorithm":"Reimbursement will be 79.1% of billable gross charges.","estimated_amount":308.08,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":370.01,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":153.84,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"POS","standard_charge_percentage":55.90,"standard_charge_algorithm":"Reimbursement will be 55.9% of billable gross charges.","estimated_amount":217.72,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"PPO","standard_charge_percentage":55.90,"standard_charge_algorithm":"Reimbursement will be 55.9% of billable gross charges.","estimated_amount":217.72,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QEP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":370.01,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QHP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":370.01,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"TRAD","standard_charge_percentage":55.90,"standard_charge_algorithm":"Reimbursement will be 55.9% of billable gross charges.","estimated_amount":217.72,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":58.00,"standard_charge_algorithm":"Reimbursement will be 58% of billable gross charges.","estimated_amount":225.90,"methodology":"percent of total billed charges"},{"payer_name":"Corizon Health","plan_name":"LOCALGOV","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":144.11,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":350.53,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":350.53,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":311.58,"methodology":"percent of total billed charges"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":331.06,"methodology":"percent of total billed charges"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_percentage":72.30,"standard_charge_algorithm":"Reimbursement will be 72.3% of billable gross charges.","estimated_amount":281.59,"methodology":"percent of total billed charges"},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":64.70,"standard_charge_algorithm":"Reimbursement will be 64.7% of billable gross charges.","estimated_amount":251.99,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":176.43,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":311.58,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":311.58,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":233.69,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":350.53,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":350.53,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":253.16,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"QHP","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":253.16,"methodology":"percent of total billed charges"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":153.84,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":65.70,"standard_charge_algorithm":"Reimbursement will be 65.7% of billable gross charges.","estimated_amount":255.89,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB KN BRG 8 12MM ","code_information":[{"code":"402725","type":"CDM"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":8543.00,"discounted_cash":8543.00,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":79.10,"standard_charge_algorithm":"Reimbursement will be 79.1% of billable gross charges.","estimated_amount":6757.51,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":8115.85,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":3374.49,"methodology":"percent of total billed charges"},{"payer_name":"Blue 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Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":13.24,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":9.56,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"QHP","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":9.56,"methodology":"percent of total billed charges"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":5.81,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":65.70,"standard_charge_algorithm":"Reimbursement will be 65.7% of billable gross charges.","estimated_amount":9.66,"methodology":"percent of total billed charges"}]}]},{"description":"INSULIN 5 U INJ ","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"641757","type":"CDM"},{"code":"J1815","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":8.91,"discounted_cash":8.91,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":79.10,"standard_charge_algorithm":"Reimbursement will be 79.1% of billable gross charges.","estimated_amount":7.05,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":8.46,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":3.52,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"POS","standard_charge_percentage":55.90,"standard_charge_algorithm":"Reimbursement will be 55.9% of billable gross charges.","estimated_amount":4.98,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"PPO","standard_charge_percentage":55.90,"standard_charge_algorithm":"Reimbursement will be 55.9% of billable gross charges.","estimated_amount":4.98,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QEP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":8.46,"methodology":"percent of total billed charges"},{"payer_name":"Blue 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Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":8.02,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":8.02,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":7.13,"methodology":"percent of total billed charges"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":7.57,"methodology":"percent of total billed charges"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_percentage":72.30,"standard_charge_algorithm":"Reimbursement will be 72.3% of billable gross charges.","estimated_amount":6.44,"methodology":"percent of total billed charges"},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":64.70,"standard_charge_algorithm":"Reimbursement will be 64.7% of billable gross charges.","estimated_amount":5.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":4.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":7.13,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":7.13,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":5.35,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":8.02,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus 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charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":65.70,"standard_charge_algorithm":"Reimbursement will be 65.7% of billable gross charges.","estimated_amount":5.85,"methodology":"percent of total billed charges"}]}]},{"description":"INTBDY SPN 7D 20X15X8MM ","code_information":[{"code":"95541","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":9257.00,"discounted_cash":9257.00,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":79.10,"standard_charge_algorithm":"Reimbursement will be 79.1% of billable gross charges.","estimated_amount":7322.29,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":8794.15,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":3656.51,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QEP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":8794.15,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QHP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":8794.15,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":58.00,"standard_charge_algorithm":"Reimbursement will be 58% of billable gross charges.","estimated_amount":5369.06,"methodology":"percent of total billed charges"},{"payer_name":"Corizon Health","plan_name":"LOCALGOV","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":3425.09,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":8331.30,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":8331.30,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":7405.60,"methodology":"percent of total billed charges"},{"payer_name":"GEHA PPO 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charges"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":7405.60,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":7405.60,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":5554.20,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":8331.30,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":8331.30,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":6017.05,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"QHP","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":6017.05,"methodology":"percent of total billed charges"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":3656.51,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":65.70,"standard_charge_algorithm":"Reimbursement will be 65.7% of billable gross charges.","estimated_amount":6081.85,"methodology":"percent of total billed charges"}]}]},{"description":"INTERSTITIAL LUNG DISEASE WITH MCC ","code_information":[{"code":"196","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":750.00,"maximum":39532.36,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":80.90,"standard_charge_algorithm":"Reimbursement will be 80.9% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_dollar":13752.67,"methodology":"fee schedule"},{"payer_name":"Blue Cross","plan_name":"POS","standard_charge_dollar":39532.36,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"PPO","standard_charge_dollar":39532.36,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"QEP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QHP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"TRAD","standard_charge_dollar":39532.36,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Business Psychology Associates","plan_name":"COMM","standard_charge_dollar":750.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":60.10,"standard_charge_algorithm":"Reimbursement will be 60.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Corizon Health","plan_name":"LOCALGOV","standard_charge_dollar":17719.19,"methodology":"fee schedule"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"EverNorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_dollar":15280.74,"methodology":"fee schedule"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRHMO","standard_charge_dollar":15280.74,"methodology":"fee schedule"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRPPO","standard_charge_dollar":15280.74,"methodology":"fee schedule"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_dollar":27702.74,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $79229.83, reimbursement will be 61.2% of billable gross charges instead of the contracted rate."},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":66.10,"standard_charge_algorithm":"Reimbursement will be 66.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":15280.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":62.00,"standard_charge_algorithm":"Reimbursement will be 62% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_dollar":37751.53,"methodology":"fee schedule"},{"payer_name":"St Luke's Health Partners","plan_name":"QHP","standard_charge_dollar":19809.78,"methodology":"fee schedule"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_dollar":13752.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":15825.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $199902.00, reimbursement will be $9841 per diem instead of the contracted rate."},{"payer_name":"United  ","plan_name":"MGMCR","standard_charge_dollar":14516.70,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":69.00,"standard_charge_algorithm":"Reimbursement will be 69% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veteran's Administration","plan_name":"FEDERAL","standard_charge_dollar":15280.74,"methodology":"fee schedule"}]}]},{"description":"INTRACARDIAC ECHO ","code_information":[{"code":"45256","type":"CDM"},{"code":"93662","type":"CPT"}],"standard_charges":[{"setting":"outpatient","gross_charge":20729.39,"discounted_cash":20729.39,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":79.10,"standard_charge_algorithm":"Reimbursement will be 79.1% of billable gross 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charges.","estimated_amount":12023.05,"methodology":"percent of total billed charges"},{"payer_name":"Corizon Health","plan_name":"LOCALGOV","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":7669.87,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":18656.45,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":18656.45,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":16583.51,"methodology":"percent of total billed charges"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":17619.98,"methodology":"percent of total billed charges"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_percentage":72.30,"standard_charge_algorithm":"Reimbursement will be 72.3% of billable gross charges.","estimated_amount":14987.35,"methodology":"percent of total billed charges"},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":64.70,"standard_charge_algorithm":"Reimbursement will be 64.7% of billable gross charges.","estimated_amount":13411.92,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":9390.41,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":16583.51,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":16583.51,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":12437.63,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":18656.45,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":18656.45,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":13474.10,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"QHP","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":13474.10,"methodology":"percent of total billed charges"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":8188.11,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":65.70,"standard_charge_algorithm":"Reimbursement will be 65.7% of billable gross charges.","estimated_amount":13619.21,"methodology":"percent of total billed charges"}]}]},{"description":"INTRAOCULAR PROCEDURES WITHOUT CC/MCC ","code_information":[{"code":"117","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":750.00,"maximum":27836.00,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":80.90,"standard_charge_algorithm":"Reimbursement will be 80.9% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_dollar":8398.72,"methodology":"fee schedule"},{"payer_name":"Blue Cross","plan_name":"POS","standard_charge_dollar":24995.03,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"PPO","standard_charge_dollar":24995.03,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"QEP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QHP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"TRAD","standard_charge_dollar":24995.03,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Business Psychology Associates","plan_name":"COMM","standard_charge_dollar":750.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":60.10,"standard_charge_algorithm":"Reimbursement will be 60.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Corizon Health","plan_name":"LOCALGOV","standard_charge_dollar":10143.25,"methodology":"fee schedule"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"EverNorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_dollar":9331.92,"methodology":"fee schedule"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRHMO","standard_charge_dollar":9331.92,"methodology":"fee schedule"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRPPO","standard_charge_dollar":9331.92,"methodology":"fee schedule"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_dollar":18133.93,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $51863.05, reimbursement will be 61.2% of billable gross charges instead of the contracted rate."},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":66.10,"standard_charge_algorithm":"Reimbursement will be 66.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":9331.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":62.00,"standard_charge_algorithm":"Reimbursement will be 62% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_dollar":21568.58,"methodology":"fee schedule"},{"payer_name":"St Luke's Health Partners","plan_name":"QHP","standard_charge_dollar":11317.92,"methodology":"fee schedule"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_dollar":8398.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":27836.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $199902.00, reimbursement will be $9841 per diem instead of the contracted rate."},{"payer_name":"United  ","plan_name":"MGMCR","standard_charge_dollar":8865.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":69.00,"standard_charge_algorithm":"Reimbursement will be 69% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veteran's Administration","plan_name":"FEDERAL","standard_charge_dollar":9331.92,"methodology":"fee schedule"}]}]},{"description":"INTRO 8.5FR 180CM 63CM ","code_information":[{"code":"86601","type":"CDM"},{"code":"C1893","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":5106.00,"discounted_cash":5106.00,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":79.10,"standard_charge_algorithm":"Reimbursement will be 79.1% of billable 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charges.","estimated_amount":2313.02,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":4084.80,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":4084.80,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross 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Health","plan_name":"WCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":86.52,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":76.90,"methodology":"percent of total billed charges"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":81.71,"methodology":"percent of total billed charges"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_percentage":72.30,"standard_charge_algorithm":"Reimbursement will be 72.3% of billable gross charges.","estimated_amount":69.50,"methodology":"percent of total billed charges"},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":64.70,"standard_charge_algorithm":"Reimbursement will be 64.7% of billable gross charges.","estimated_amount":62.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":43.55,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":76.90,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":76.90,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":57.68,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":86.52,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":86.52,"methodology":"percent of total billed charges"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":37.97,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":65.70,"standard_charge_algorithm":"Reimbursement will be 65.7% of billable gross charges.","estimated_amount":63.16,"methodology":"percent of total billed charges"}]}]},{"description":"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC A ","code_information":[{"code":"063","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":750.00,"maximum":34347.22,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":80.90,"standard_charge_algorithm":"Reimbursement will be 80.9% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue 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If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"PPO","standard_charge_dollar":31010.19,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"QEP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QHP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"TRAD","standard_charge_dollar":31010.19,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Business Psychology Associates","plan_name":"COMM","standard_charge_dollar":750.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":60.10,"standard_charge_algorithm":"Reimbursement will be 60.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Corizon Health","plan_name":"LOCALGOV","standard_charge_dollar":13209.93,"methodology":"fee schedule"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"EverNorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_dollar":11739.95,"methodology":"fee schedule"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRHMO","standard_charge_dollar":11739.95,"methodology":"fee schedule"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRPPO","standard_charge_dollar":11739.95,"methodology":"fee schedule"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_dollar":27792.03,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $79485.20, reimbursement will be 61.2% of billable gross charges instead of the contracted rate."},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":66.10,"standard_charge_algorithm":"Reimbursement will be 66.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":11739.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":62.00,"standard_charge_algorithm":"Reimbursement will be 62% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_dollar":34347.22,"methodology":"fee schedule"},{"payer_name":"St Luke's Health Partners","plan_name":"QHP","standard_charge_dollar":18023.40,"methodology":"fee schedule"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_dollar":10565.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":15825.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $199902.00, reimbursement will be $9841 per diem instead of the contracted rate."},{"payer_name":"United  ","plan_name":"MGMCR","standard_charge_dollar":11152.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":69.00,"standard_charge_algorithm":"Reimbursement will be 69% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veteran's Administration","plan_name":"FEDERAL","standard_charge_dollar":11739.95,"methodology":"fee schedule"}]}]},{"description":"ISOSORB DIN 20MG PO ","code_information":[{"code":"641798","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":22.84,"discounted_cash":22.84,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":79.10,"standard_charge_algorithm":"Reimbursement will be 79.1% of billable gross 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charges.","estimated_amount":12.77,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QEP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":21.70,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QHP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":21.70,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"TRAD","standard_charge_percentage":55.90,"standard_charge_algorithm":"Reimbursement will be 55.9% of billable gross charges.","estimated_amount":12.77,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":58.00,"standard_charge_algorithm":"Reimbursement will be 58% of billable gross charges.","estimated_amount":13.25,"methodology":"percent of total billed charges"},{"payer_name":"Corizon Health","plan_name":"LOCALGOV","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":8.45,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":20.56,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":20.56,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":18.27,"methodology":"percent of total billed charges"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":19.41,"methodology":"percent of total billed charges"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_percentage":72.30,"standard_charge_algorithm":"Reimbursement will be 72.3% of billable gross charges.","estimated_amount":16.51,"methodology":"percent of total billed charges"},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":64.70,"standard_charge_algorithm":"Reimbursement will be 64.7% of billable gross charges.","estimated_amount":14.78,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":10.35,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":18.27,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":18.27,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":13.70,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":20.56,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":20.56,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":14.85,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"QHP","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":14.85,"methodology":"percent of total billed charges"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":9.02,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":65.70,"standard_charge_algorithm":"Reimbursement will be 65.7% of billable gross charges.","estimated_amount":15.01,"methodology":"percent of total billed charges"}]}]},{"description":"IV ADDL SEQ INF UP TO 1H ","code_information":[{"code":"46684","type":"CDM"},{"code":"96367","type":"CPT"}],"standard_charges":[{"setting":"outpatient","gross_charge":182.25,"discounted_cash":182.25,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":79.10,"standard_charge_algorithm":"Reimbursement will be 79.1% of billable gross 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charges"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":38.15,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":38.15,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":28.61,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":42.92,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":42.92,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":31.00,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"QHP","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":31.00,"methodology":"percent of total billed charges"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":18.84,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":65.70,"standard_charge_algorithm":"Reimbursement will be 65.7% of billable gross charges.","estimated_amount":31.33,"methodology":"percent of total billed charges"}]}]},{"description":"KI67 PEROX EACH ADDL AB ","code_information":[{"code":"45874","type":"CDM"},{"code":"88341","type":"CPT"}],"standard_charges":[{"setting":"outpatient","gross_charge":389.48,"discounted_cash":389.48,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":79.10,"standard_charge_algorithm":"Reimbursement will be 79.1% of billable gross charges.","estimated_amount":308.08,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":370.01,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":153.84,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"POS","standard_charge_percentage":55.90,"standard_charge_algorithm":"Reimbursement will be 55.9% of billable gross charges.","estimated_amount":217.72,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"PPO","standard_charge_percentage":55.90,"standard_charge_algorithm":"Reimbursement will be 55.9% of billable gross charges.","estimated_amount":217.72,"methodology":"percent of total billed charges"},{"payer_name":"Blue 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Health","plan_name":"LOCALGOV","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":144.11,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":350.53,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":350.53,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":311.58,"methodology":"percent of total billed charges"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":331.06,"methodology":"percent of total billed charges"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_percentage":72.30,"standard_charge_algorithm":"Reimbursement will be 72.3% of billable gross charges.","estimated_amount":281.59,"methodology":"percent of total billed charges"},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":64.70,"standard_charge_algorithm":"Reimbursement will be 64.7% of billable gross charges.","estimated_amount":251.99,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":176.43,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":311.58,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":311.58,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":233.69,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":350.53,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":350.53,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":253.16,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"QHP","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":253.16,"methodology":"percent of total billed charges"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":153.84,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":65.70,"standard_charge_algorithm":"Reimbursement will be 65.7% of billable gross charges.","estimated_amount":255.89,"methodology":"percent of total billed charges"}]}]},{"description":"KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC ","code_information":[{"code":"690","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":750.00,"maximum":17284.41,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":80.90,"standard_charge_algorithm":"Reimbursement will be 80.9% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_dollar":6564.45,"methodology":"fee schedule"},{"payer_name":"Blue Cross","plan_name":"POS","standard_charge_dollar":16829.51,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"PPO","standard_charge_dollar":16829.51,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"QEP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QHP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"TRAD","standard_charge_dollar":16829.51,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Business Psychology Associates","plan_name":"COMM","standard_charge_dollar":750.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":60.10,"standard_charge_algorithm":"Reimbursement will be 60.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Corizon Health","plan_name":"LOCALGOV","standard_charge_dollar":7547.72,"methodology":"fee schedule"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"EverNorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_dollar":7293.84,"methodology":"fee schedule"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRHMO","standard_charge_dollar":7293.84,"methodology":"fee schedule"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRPPO","standard_charge_dollar":7293.84,"methodology":"fee schedule"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_dollar":13075.88,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $37397.01, reimbursement will be 61.2% of billable gross charges instead of the contracted rate."},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":66.10,"standard_charge_algorithm":"Reimbursement will be 66.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":7293.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":62.00,"standard_charge_algorithm":"Reimbursement will be 62% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_dollar":17284.41,"methodology":"fee schedule"},{"payer_name":"St Luke's Health Partners","plan_name":"QHP","standard_charge_dollar":9069.84,"methodology":"fee schedule"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_dollar":6564.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":15825.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $199902.00, reimbursement will be $9841 per diem instead of the contracted rate."},{"payer_name":"United  ","plan_name":"MGMCR","standard_charge_dollar":6929.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":69.00,"standard_charge_algorithm":"Reimbursement will be 69% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veteran's Administration","plan_name":"FEDERAL","standard_charge_dollar":7293.84,"methodology":"fee schedule"}]}]},{"description":"KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC ","code_information":[{"code":"651","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":750.00,"maximum":77041.19,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":80.90,"standard_charge_algorithm":"Reimbursement will be 80.9% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_dollar":24306.37,"methodology":"fee schedule"},{"payer_name":"Blue Cross","plan_name":"POS","standard_charge_dollar":72131.85,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"PPO","standard_charge_dollar":72131.85,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"QEP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QHP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"TRAD","standard_charge_dollar":72131.85,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Business Psychology Associates","plan_name":"COMM","standard_charge_dollar":750.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":60.10,"standard_charge_algorithm":"Reimbursement will be 60.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Corizon Health","plan_name":"LOCALGOV","standard_charge_dollar":32652.88,"methodology":"fee schedule"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"EverNorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_dollar":27007.08,"methodology":"fee schedule"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRHMO","standard_charge_dollar":27007.08,"methodology":"fee schedule"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRPPO","standard_charge_dollar":27007.08,"methodology":"fee schedule"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_percentage":69.50,"standard_charge_algorithm":"Reimbursement will be 69.5% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":66.10,"standard_charge_algorithm":"Reimbursement will be 66.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":27007.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":62.00,"standard_charge_algorithm":"Reimbursement will be 62% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_dollar":77041.19,"methodology":"fee schedule"},{"payer_name":"St Luke's Health Partners","plan_name":"QHP","standard_charge_dollar":40426.68,"methodology":"fee schedule"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_dollar":24306.37,"methodology":"fee schedule"},{"payer_name":"Veteran's Administration","plan_name":"FEDERAL","standard_charge_dollar":27007.08,"methodology":"fee schedule"}]}]},{"description":"KIT ANCHOR INST 2.9MM ","code_information":[{"code":"402776","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":5248.00,"discounted_cash":5248.00,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":79.10,"standard_charge_algorithm":"Reimbursement will be 79.1% of billable gross charges.","estimated_amount":4151.17,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":4985.60,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":2072.96,"methodology":"percent of total billed charges"},{"payer_name":"Blue 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charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":2680.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":4733.60,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":4733.60,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":3550.20,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":5325.30,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":5325.30,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":3846.05,"methodology":"percent of total 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be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"PPO","standard_charge_dollar":41453.29,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"QEP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QHP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"TRAD","standard_charge_dollar":41453.29,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. 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charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":41.55,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":17.28,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"POS","standard_charge_percentage":55.90,"standard_charge_algorithm":"Reimbursement will be 55.9% of billable gross charges.","estimated_amount":24.45,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"PPO","standard_charge_percentage":55.90,"standard_charge_algorithm":"Reimbursement will be 55.9% of billable gross charges.","estimated_amount":24.45,"methodology":"percent of total billed charges"},{"payer_name":"Blue 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charges"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":34.99,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":34.99,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":26.24,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":39.37,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":39.37,"methodology":"percent of total billed charges"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":17.28,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":65.70,"standard_charge_algorithm":"Reimbursement will be 65.7% of billable gross charges.","estimated_amount":28.74,"methodology":"percent of total billed 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Health","plan_name":"LOCALGOV","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":16.44,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":39.99,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":39.99,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":35.54,"methodology":"percent of total billed charges"},{"payer_name":"GEHA PPO 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charges"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":35.54,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":35.54,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":26.66,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":39.99,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":39.99,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":28.88,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"QHP","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":28.88,"methodology":"percent of total billed charges"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":17.55,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":65.70,"standard_charge_algorithm":"Reimbursement will be 65.7% of billable gross charges.","estimated_amount":29.19,"methodology":"percent of total billed charges"}]}]},{"description":"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC ","code_information":[{"code":"493","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":750.00,"maximum":51614.25,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":80.90,"standard_charge_algorithm":"Reimbursement will be 80.9% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_dollar":17187.27,"methodology":"fee schedule"},{"payer_name":"Blue Cross","plan_name":"POS","standard_charge_dollar":50092.26,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"PPO","standard_charge_dollar":50092.26,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"QEP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QHP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"TRAD","standard_charge_dollar":50092.26,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Business Psychology Associates","plan_name":"COMM","standard_charge_dollar":750.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":60.10,"standard_charge_algorithm":"Reimbursement will be 60.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Corizon Health","plan_name":"LOCALGOV","standard_charge_dollar":22579.22,"methodology":"fee schedule"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"EverNorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_dollar":19096.97,"methodology":"fee schedule"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRHMO","standard_charge_dollar":19096.97,"methodology":"fee schedule"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRPPO","standard_charge_dollar":19096.97,"methodology":"fee schedule"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_dollar":38063.57,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $108861.81, reimbursement will be 61.2% of billable gross charges instead of the contracted rate."},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":66.10,"standard_charge_algorithm":"Reimbursement will be 66.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":19096.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":62.00,"standard_charge_algorithm":"Reimbursement will be 62% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_dollar":51614.25,"methodology":"fee schedule"},{"payer_name":"St Luke's Health Partners","plan_name":"QHP","standard_charge_dollar":27084.12,"methodology":"fee schedule"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_dollar":17187.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":35967.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"United  ","plan_name":"MGMCR","standard_charge_dollar":18142.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":69.00,"standard_charge_algorithm":"Reimbursement will be 69% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veteran's Administration","plan_name":"FEDERAL","standard_charge_dollar":19096.97,"methodology":"fee schedule"}]}]},{"description":"LURASIDONE 80MG PO ","code_information":[{"code":"644414","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":120.25,"discounted_cash":120.25,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":79.10,"standard_charge_algorithm":"Reimbursement will be 79.1% of billable gross charges.","estimated_amount":95.12,"methodology":"percent of total billed charges"},{"payer_name":"Blue 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charges"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":96.20,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":96.20,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":72.15,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":108.22,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":108.22,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":78.16,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"QHP","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":78.16,"methodology":"percent of total 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dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":960.78,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":720.59,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1080.88,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus 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PROCEDURES WITHOUT CC/MCC ","code_information":[{"code":"822","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":750.00,"maximum":27836.00,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":80.90,"standard_charge_algorithm":"Reimbursement will be 80.9% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_dollar":8830.71,"methodology":"fee schedule"},{"payer_name":"Blue Cross","plan_name":"POS","standard_charge_dollar":25837.65,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"PPO","standard_charge_dollar":25837.65,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"QEP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QHP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"TRAD","standard_charge_dollar":25837.65,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Business Psychology Associates","plan_name":"COMM","standard_charge_dollar":750.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":60.10,"standard_charge_algorithm":"Reimbursement will be 60.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Corizon Health","plan_name":"LOCALGOV","standard_charge_dollar":10754.52,"methodology":"fee schedule"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"EverNorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_dollar":9811.90,"methodology":"fee schedule"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRHMO","standard_charge_dollar":9811.90,"methodology":"fee schedule"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRPPO","standard_charge_dollar":9811.90,"methodology":"fee schedule"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_dollar":20906.85,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $59793.60, reimbursement will be 61.2% of billable gross charges instead of the contracted rate."},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":66.10,"standard_charge_algorithm":"Reimbursement will be 66.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":9811.90,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":62.00,"standard_charge_algorithm":"Reimbursement will be 62% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_dollar":26178.63,"methodology":"fee schedule"},{"payer_name":"St Luke's Health Partners","plan_name":"QHP","standard_charge_dollar":13737.00,"methodology":"fee schedule"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_dollar":8830.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":27836.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $199902.00, reimbursement will be $9841 per diem instead of the contracted rate."},{"payer_name":"United  ","plan_name":"MGMCR","standard_charge_dollar":9321.30,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":69.00,"standard_charge_algorithm":"Reimbursement will be 69% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veteran's Administration","plan_name":"FEDERAL","standard_charge_dollar":9811.90,"methodology":"fee schedule"}]}]},{"description":"M A IHC HER-2NEU QT/SQT ","code_information":[{"code":"45963","type":"CDM"},{"code":"88360","type":"CPT"}],"standard_charges":[{"setting":"outpatient","gross_charge":389.48,"discounted_cash":389.48,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":79.10,"standard_charge_algorithm":"Reimbursement will be 79.1% of billable gross 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charges.","estimated_amount":225.90,"methodology":"percent of total billed charges"},{"payer_name":"Corizon Health","plan_name":"LOCALGOV","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":144.11,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":350.53,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":350.53,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross 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charges.","estimated_amount":176.43,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":311.58,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":311.58,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross 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billable gross charges.","estimated_amount":253.16,"methodology":"percent of total billed charges"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":153.84,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":65.70,"standard_charge_algorithm":"Reimbursement will be 65.7% of billable gross charges.","estimated_amount":255.89,"methodology":"percent of total billed charges"}]}]},{"description":"MAG SULFATE 1G INJ ","drug_information":{"unit":"1","type":"GM"},"code_information":[{"code":"642351","type":"CDM"},{"code":"J3475","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":89.38,"discounted_cash":89.38,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":79.10,"standard_charge_algorithm":"Reimbursement will be 79.1% of billable gross charges.","estimated_amount":70.70,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":84.91,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":35.31,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"POS","standard_charge_percentage":55.90,"standard_charge_algorithm":"Reimbursement will be 55.9% of billable gross charges.","estimated_amount":49.96,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"PPO","standard_charge_percentage":55.90,"standard_charge_algorithm":"Reimbursement will be 55.9% of billable gross charges.","estimated_amount":49.96,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QEP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":84.91,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QHP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":84.91,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"TRAD","standard_charge_percentage":55.90,"standard_charge_algorithm":"Reimbursement will be 55.9% of billable gross charges.","estimated_amount":49.96,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":58.00,"standard_charge_algorithm":"Reimbursement will be 58% of billable gross 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logic."},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":100.38,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":75.28,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":112.92,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":112.92,"methodology":"percent of total billed charges"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":49.56,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":65.70,"standard_charge_algorithm":"Reimbursement will be 65.7% of billable gross charges.","estimated_amount":82.43,"methodology":"percent of total billed charges"}]}]},{"description":"MAJOR CHEST TRAUMA WITH CC ","code_information":[{"code":"184","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":750.00,"maximum":22706.97,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":80.90,"standard_charge_algorithm":"Reimbursement will be 80.9% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_dollar":8328.28,"methodology":"fee schedule"},{"payer_name":"Blue Cross","plan_name":"POS","standard_charge_dollar":21939.48,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"PPO","standard_charge_dollar":21939.48,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"QEP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QHP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"TRAD","standard_charge_dollar":21939.48,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Business Psychology Associates","plan_name":"COMM","standard_charge_dollar":750.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":60.10,"standard_charge_algorithm":"Reimbursement will be 60.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Corizon Health","plan_name":"LOCALGOV","standard_charge_dollar":10043.57,"methodology":"fee schedule"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"EverNorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_dollar":9253.64,"methodology":"fee schedule"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRHMO","standard_charge_dollar":9253.64,"methodology":"fee schedule"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRPPO","standard_charge_dollar":9253.64,"methodology":"fee schedule"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_dollar":16835.94,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $48150.78, reimbursement will be 61.2% of billable gross charges instead of the contracted rate."},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":66.10,"standard_charge_algorithm":"Reimbursement will be 66.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":9253.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":62.00,"standard_charge_algorithm":"Reimbursement will be 62% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_dollar":22706.97,"methodology":"fee schedule"},{"payer_name":"St Luke's Health Partners","plan_name":"QHP","standard_charge_dollar":11915.28,"methodology":"fee schedule"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_dollar":8328.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":15825.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $199902.00, reimbursement will be $9841 per diem instead of the contracted rate."},{"payer_name":"United  ","plan_name":"MGMCR","standard_charge_dollar":8790.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":69.00,"standard_charge_algorithm":"Reimbursement will be 69% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veteran's Administration","plan_name":"FEDERAL","standard_charge_dollar":9253.64,"methodology":"fee schedule"}]}]},{"description":"MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC ","code_information":[{"code":"373","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":750.00,"maximum":15825.00,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":80.90,"standard_charge_algorithm":"Reimbursement will be 80.9% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_dollar":6050.72,"methodology":"fee schedule"},{"payer_name":"Blue Cross","plan_name":"POS","standard_charge_dollar":14944.04,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"PPO","standard_charge_dollar":14944.04,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"QEP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QHP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"TRAD","standard_charge_dollar":14944.04,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Business Psychology Associates","plan_name":"COMM","standard_charge_dollar":750.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":60.10,"standard_charge_algorithm":"Reimbursement will be 60.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Corizon Health","plan_name":"LOCALGOV","standard_charge_dollar":6820.79,"methodology":"fee schedule"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"EverNorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_dollar":6723.03,"methodology":"fee schedule"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRHMO","standard_charge_dollar":6723.03,"methodology":"fee schedule"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRPPO","standard_charge_dollar":6723.03,"methodology":"fee schedule"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_dollar":12265.66,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $35079.80, reimbursement will be 61.2% of billable gross charges instead of the contracted rate."},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":66.10,"standard_charge_algorithm":"Reimbursement will be 66.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":6723.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":62.00,"standard_charge_algorithm":"Reimbursement will be 62% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_dollar":15772.35,"methodology":"fee schedule"},{"payer_name":"St Luke's Health Partners","plan_name":"QHP","standard_charge_dollar":8276.40,"methodology":"fee schedule"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_dollar":6050.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":15825.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $199902.00, reimbursement will be $9841 per diem instead of the contracted rate."},{"payer_name":"United  ","plan_name":"MGMCR","standard_charge_dollar":6386.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":69.00,"standard_charge_algorithm":"Reimbursement will be 69% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veteran's Administration","plan_name":"FEDERAL","standard_charge_dollar":6723.03,"methodology":"fee schedule"}]}]},{"description":"MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT ","code_information":[{"code":"470","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":750.00,"maximum":53586.00,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":80.90,"standard_charge_algorithm":"Reimbursement will be 80.9% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_dollar":13761.31,"methodology":"fee schedule"},{"payer_name":"Blue Cross","plan_name":"POS","standard_charge_dollar":39246.62,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"PPO","standard_charge_dollar":39246.62,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"QEP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QHP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"TRAD","standard_charge_dollar":39246.62,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Business Psychology Associates","plan_name":"COMM","standard_charge_dollar":750.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":60.10,"standard_charge_algorithm":"Reimbursement will be 60.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Corizon Health","plan_name":"LOCALGOV","standard_charge_dollar":17731.41,"methodology":"fee schedule"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"EverNorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_dollar":15290.34,"methodology":"fee schedule"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRHMO","standard_charge_dollar":15290.34,"methodology":"fee schedule"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRPPO","standard_charge_dollar":15290.34,"methodology":"fee schedule"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_dollar":32547.49,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $93085.83, reimbursement will be 61.2% of billable gross charges instead of the contracted rate."},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":66.10,"standard_charge_algorithm":"Reimbursement will be 66.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":15290.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":62.00,"standard_charge_algorithm":"Reimbursement will be 62% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_dollar":41536.03,"methodology":"fee schedule"},{"payer_name":"St Luke's Health Partners","plan_name":"QHP","standard_charge_dollar":21795.66,"methodology":"fee schedule"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_dollar":13761.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":53586.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"United  ","plan_name":"MGMCR","standard_charge_dollar":14525.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":69.00,"standard_charge_algorithm":"Reimbursement will be 69% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veteran's Administration","plan_name":"FEDERAL","standard_charge_dollar":15290.34,"methodology":"fee schedule"}]}]},{"description":"MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC ","code_information":[{"code":"330","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":750.00,"maximum":53343.57,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":80.90,"standard_charge_algorithm":"Reimbursement will be 80.9% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_dollar":16939.39,"methodology":"fee schedule"},{"payer_name":"Blue Cross","plan_name":"POS","standard_charge_dollar":49474.89,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"PPO","standard_charge_dollar":49474.89,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"QEP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QHP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"TRAD","standard_charge_dollar":49474.89,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Business Psychology Associates","plan_name":"COMM","standard_charge_dollar":750.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":60.10,"standard_charge_algorithm":"Reimbursement will be 60.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Corizon Health","plan_name":"LOCALGOV","standard_charge_dollar":22228.45,"methodology":"fee schedule"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"EverNorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_dollar":18821.54,"methodology":"fee schedule"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRHMO","standard_charge_dollar":18821.54,"methodology":"fee schedule"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRPPO","standard_charge_dollar":18821.54,"methodology":"fee schedule"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_dollar":41780.64,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $119492.62, reimbursement will be 61.2% of billable gross charges instead of the contracted rate."},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":66.10,"standard_charge_algorithm":"Reimbursement will be 66.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":18821.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":62.00,"standard_charge_algorithm":"Reimbursement will be 62% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_dollar":53343.57,"methodology":"fee schedule"},{"payer_name":"St Luke's Health Partners","plan_name":"QHP","standard_charge_dollar":27991.56,"methodology":"fee schedule"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_dollar":16939.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":27836.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $199902.00, reimbursement will be $9841 per diem instead of the contracted rate."},{"payer_name":"United  ","plan_name":"MGMCR","standard_charge_dollar":17880.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":69.00,"standard_charge_algorithm":"Reimbursement will be 69% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veteran's Administration","plan_name":"FEDERAL","standard_charge_dollar":18821.54,"methodology":"fee schedule"}]}]},{"description":"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH MCC ","code_information":[{"code":"754","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":750.00,"maximum":38637.59,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":80.90,"standard_charge_algorithm":"Reimbursement will be 80.9% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_dollar":13254.23,"methodology":"fee schedule"},{"payer_name":"Blue Cross","plan_name":"POS","standard_charge_dollar":38637.59,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"PPO","standard_charge_dollar":38637.59,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"QEP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QHP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"TRAD","standard_charge_dollar":38637.59,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Business Psychology Associates","plan_name":"COMM","standard_charge_dollar":750.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":60.10,"standard_charge_algorithm":"Reimbursement will be 60.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Corizon Health","plan_name":"LOCALGOV","standard_charge_dollar":17013.88,"methodology":"fee schedule"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"EverNorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_dollar":14726.92,"methodology":"fee schedule"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRHMO","standard_charge_dollar":14726.92,"methodology":"fee schedule"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRPPO","standard_charge_dollar":14726.92,"methodology":"fee schedule"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_dollar":29133.02,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $83320.43, reimbursement will be 61.2% of billable gross charges instead of the contracted rate."},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":66.10,"standard_charge_algorithm":"Reimbursement will be 66.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":14726.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":62.00,"standard_charge_algorithm":"Reimbursement will be 62% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_dollar":37734.15,"methodology":"fee schedule"},{"payer_name":"St Luke's Health Partners","plan_name":"QHP","standard_charge_dollar":19800.66,"methodology":"fee schedule"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_dollar":13254.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":15825.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $199902.00, reimbursement will be $9841 per diem instead of the contracted rate."},{"payer_name":"United  ","plan_name":"MGMCR","standard_charge_dollar":13990.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":69.00,"standard_charge_algorithm":"Reimbursement will be 69% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veteran's Administration","plan_name":"FEDERAL","standard_charge_dollar":14726.92,"methodology":"fee schedule"}]}]},{"description":"MAMMAGLOBIN AB IHC ","code_information":[{"code":"45772","type":"CDM"},{"code":"88342","type":"CPT"}],"standard_charges":[{"setting":"outpatient","gross_charge":389.48,"discounted_cash":389.48,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":79.10,"standard_charge_algorithm":"Reimbursement will be 79.1% of billable gross 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be further adjusted for multiple procedure logic."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":157.17,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":235.75,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":235.75,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross 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Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":19.41,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":19.41,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":17.26,"methodology":"percent of total billed charges"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":18.33,"methodology":"percent of total billed charges"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_percentage":72.30,"standard_charge_algorithm":"Reimbursement will be 72.3% of billable gross charges.","estimated_amount":15.60,"methodology":"percent of total billed charges"},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":64.70,"standard_charge_algorithm":"Reimbursement will be 64.7% of billable gross charges.","estimated_amount":13.96,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":9.77,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":17.26,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":17.26,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":12.94,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":19.41,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":19.41,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":14.02,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"QHP","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":14.02,"methodology":"percent of total billed charges"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":8.52,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":65.70,"standard_charge_algorithm":"Reimbursement will be 65.7% of billable gross charges.","estimated_amount":14.17,"methodology":"percent of total billed charges"}]}]},{"description":"MELANIN A EA ADDL AB IHC ","code_information":[{"code":"45479","type":"CDM"},{"code":"88341","type":"CPT"}],"standard_charges":[{"setting":"outpatient","gross_charge":389.48,"discounted_cash":389.48,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":79.10,"standard_charge_algorithm":"Reimbursement will be 79.1% of billable gross charges.","estimated_amount":308.08,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":370.01,"methodology":"percent of total billed charges"},{"payer_name":"Blue 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dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":311.58,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":233.69,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":350.53,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus 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charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_dollar":5443.29,"methodology":"fee schedule"},{"payer_name":"Blue Cross","plan_name":"POS","standard_charge_dollar":12631.00,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"PPO","standard_charge_dollar":12631.00,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"QEP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QHP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"TRAD","standard_charge_dollar":12631.00,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Business Psychology Associates","plan_name":"COMM","standard_charge_dollar":750.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":60.10,"standard_charge_algorithm":"Reimbursement will be 60.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Corizon Health","plan_name":"LOCALGOV","standard_charge_dollar":5961.25,"methodology":"fee schedule"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"EverNorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_dollar":6048.10,"methodology":"fee schedule"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRHMO","standard_charge_dollar":6048.10,"methodology":"fee schedule"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRPPO","standard_charge_dollar":6048.10,"methodology":"fee schedule"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_dollar":9348.89,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $26737.82, reimbursement will be 61.2% of billable gross charges instead of the contracted rate."},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":66.10,"standard_charge_algorithm":"Reimbursement will be 66.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":6048.10,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":62.00,"standard_charge_algorithm":"Reimbursement will be 62% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_dollar":12289.83,"methodology":"fee schedule"},{"payer_name":"St Luke's Health Partners","plan_name":"QHP","standard_charge_dollar":6448.98,"methodology":"fee schedule"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_dollar":5443.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":15825.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $199902.00, reimbursement will be $9841 per diem instead of the contracted rate."},{"payer_name":"United  ","plan_name":"MGMCR","standard_charge_dollar":5745.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":69.00,"standard_charge_algorithm":"Reimbursement will be 69% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veteran's Administration","plan_name":"FEDERAL","standard_charge_dollar":6048.10,"methodology":"fee schedule"}]}]},{"description":"MEPIVACAIN 2% 50 ML ","code_information":[{"code":"649264","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":207.09,"discounted_cash":207.09,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":79.10,"standard_charge_algorithm":"Reimbursement will be 79.1% of billable gross 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gross charges.","estimated_amount":193.34,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":145.01,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":217.51,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":217.51,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health 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","plan_name":"MCR","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":120.41,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"POS","standard_charge_percentage":55.90,"standard_charge_algorithm":"Reimbursement will be 55.9% of billable gross charges.","estimated_amount":170.40,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"PPO","standard_charge_percentage":55.90,"standard_charge_algorithm":"Reimbursement will be 55.9% of billable gross charges.","estimated_amount":170.40,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QEP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":289.59,"methodology":"percent of total billed charges"},{"payer_name":"Blue 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dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":243.86,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":182.90,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":274.35,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus 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charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":65.70,"standard_charge_algorithm":"Reimbursement will be 65.7% of billable gross charges.","estimated_amount":200.27,"methodology":"percent of total billed charges"}]}]},{"description":"NEUROSES EXCEPT DEPRESSIVE ","code_information":[{"code":"882","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":750.00,"maximum":19590.98,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":80.90,"standard_charge_algorithm":"Reimbursement will be 80.9% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_dollar":7623.15,"methodology":"fee schedule"},{"payer_name":"Blue Cross","plan_name":"POS","standard_charge_dollar":19590.98,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"PPO","standard_charge_dollar":19590.98,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"QEP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QHP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"TRAD","standard_charge_dollar":19590.98,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Business Psychology Associates","plan_name":"COMM","standard_charge_dollar":750.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":60.10,"standard_charge_algorithm":"Reimbursement will be 60.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Corizon Health","plan_name":"LOCALGOV","standard_charge_dollar":9045.79,"methodology":"fee schedule"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_dollar":8470.16,"methodology":"fee schedule"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRHMO","standard_charge_dollar":8470.16,"methodology":"fee schedule"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRPPO","standard_charge_dollar":8470.16,"methodology":"fee schedule"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_dollar":13059.34,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $37349.72, reimbursement will be 61.2% of billable gross charges instead of the contracted rate."},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":66.10,"standard_charge_algorithm":"Reimbursement will be 66.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":8470.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":62.00,"standard_charge_algorithm":"Reimbursement will be 62% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Regence","plan_name":"HIX","standard_charge_dollar":1525.00,"methodology":"per diem"},{"payer_name":"Regence","plan_name":"PPO","standard_charge_dollar":1525.00,"methodology":"per diem"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_dollar":18976.79,"methodology":"fee schedule"},{"payer_name":"St Luke's Health Partners","plan_name":"QHP","standard_charge_dollar":9957.90,"methodology":"fee schedule"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_dollar":7623.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":15825.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $199902.00, reimbursement will be $9841 per diem instead of the contracted rate."},{"payer_name":"United  ","plan_name":"MGMCR","standard_charge_dollar":8046.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":69.00,"standard_charge_algorithm":"Reimbursement will be 69% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veteran's Administration","plan_name":"FEDERAL","standard_charge_dollar":8470.16,"methodology":"fee schedule"}]}]},{"description":"NIACIN 250MG PO ","code_information":[{"code":"641864","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":18.93,"discounted_cash":18.93,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":79.10,"standard_charge_algorithm":"Reimbursement will be 79.1% of billable gross 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charges"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":51.29,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":51.29,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":38.47,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":57.70,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":57.70,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":41.67,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"QHP","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":41.67,"methodology":"percent of total billed charges"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":25.32,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":65.70,"standard_charge_algorithm":"Reimbursement will be 65.7% of billable gross charges.","estimated_amount":42.12,"methodology":"percent of total billed charges"}]}]},{"description":"NM GASTRIC EMPTYING ","code_information":[{"code":"78264","type":"CPT"},{"code":"782641","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2520.70,"discounted_cash":2520.70,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":79.10,"standard_charge_algorithm":"Reimbursement will be 79.1% of billable gross charges.","estimated_amount":1993.87,"methodology":"percent of total billed charges"},{"payer_name":"Blue 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Cross","plan_name":"QEP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":2394.66,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QHP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":2394.66,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"TRAD","standard_charge_percentage":55.90,"standard_charge_algorithm":"Reimbursement will be 55.9% of billable gross charges.","estimated_amount":1409.07,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":58.00,"standard_charge_algorithm":"Reimbursement will be 58% of billable gross charges.","estimated_amount":1462.01,"methodology":"percent of total billed charges"},{"payer_name":"Corizon Health","plan_name":"LOCALGOV","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":932.66,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2268.63,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2268.63,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2016.56,"methodology":"percent of total billed charges"},{"payer_name":"GEHA PPO 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charges"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2016.56,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2016.56,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":1512.42,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2268.63,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2268.63,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":1638.45,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"QHP","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":1638.45,"methodology":"percent of total billed charges"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":995.68,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":65.70,"standard_charge_algorithm":"Reimbursement will be 65.7% of billable gross charges.","estimated_amount":1656.10,"methodology":"percent of total billed charges"}]}]},{"description":"NM PLANAR PARATHYROID ","code_information":[{"code":"78070","type":"CPT"},{"code":"780701","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2788.02,"discounted_cash":2788.02,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":79.10,"standard_charge_algorithm":"Reimbursement will be 79.1% of billable gross charges.","estimated_amount":2205.32,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":2648.62,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":1101.27,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"POS","standard_charge_percentage":55.90,"standard_charge_algorithm":"Reimbursement will be 55.9% of billable gross charges.","estimated_amount":1558.50,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"PPO","standard_charge_percentage":55.90,"standard_charge_algorithm":"Reimbursement will be 55.9% of billable gross charges.","estimated_amount":1558.50,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QEP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":2648.62,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QHP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":2648.62,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"TRAD","standard_charge_percentage":55.90,"standard_charge_algorithm":"Reimbursement will be 55.9% of billable gross charges.","estimated_amount":1558.50,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":58.00,"standard_charge_algorithm":"Reimbursement will be 58% of billable gross charges.","estimated_amount":1617.05,"methodology":"percent of total billed charges"},{"payer_name":"Corizon Health","plan_name":"LOCALGOV","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":1031.57,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2509.22,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2509.22,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2230.42,"methodology":"percent of total billed charges"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2369.82,"methodology":"percent of total billed charges"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_percentage":72.30,"standard_charge_algorithm":"Reimbursement will be 72.3% of billable gross charges.","estimated_amount":2015.74,"methodology":"percent of total billed charges"},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":64.70,"standard_charge_algorithm":"Reimbursement will be 64.7% of billable gross charges.","estimated_amount":1803.85,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":1262.97,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2230.42,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2230.42,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":1672.81,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2509.22,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2509.22,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":1812.21,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"QHP","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":1812.21,"methodology":"percent of total billed charges"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":1101.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":65.70,"standard_charge_algorithm":"Reimbursement will be 65.7% of billable gross charges.","estimated_amount":1831.73,"methodology":"percent of total billed charges"}]}]},{"description":"NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC ","code_information":[{"code":"097","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":750.00,"maximum":84471.15,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":80.90,"standard_charge_algorithm":"Reimbursement will be 80.9% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_dollar":25054.70,"methodology":"fee schedule"},{"payer_name":"Blue Cross","plan_name":"POS","standard_charge_dollar":75854.82,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"PPO","standard_charge_dollar":75854.82,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"QEP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QHP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"TRAD","standard_charge_dollar":75854.82,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Business Psychology Associates","plan_name":"COMM","standard_charge_dollar":750.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":60.10,"standard_charge_algorithm":"Reimbursement will be 60.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Corizon Health","plan_name":"LOCALGOV","standard_charge_dollar":33711.78,"methodology":"fee schedule"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"EverNorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_dollar":27838.56,"methodology":"fee schedule"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRHMO","standard_charge_dollar":27838.56,"methodology":"fee schedule"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRPPO","standard_charge_dollar":27838.56,"methodology":"fee schedule"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_dollar":59127.51,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $169104.67, reimbursement will be 61.2% of billable gross charges instead of the contracted rate."},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":66.10,"standard_charge_algorithm":"Reimbursement will be 66.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":27838.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":62.00,"standard_charge_algorithm":"Reimbursement will be 62% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_dollar":84471.15,"methodology":"fee schedule"},{"payer_name":"St Luke's Health Partners","plan_name":"QHP","standard_charge_dollar":44325.48,"methodology":"fee schedule"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_dollar":25054.70,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":15825.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $199902.00, reimbursement will be $9841 per diem instead of the contracted rate."},{"payer_name":"United  ","plan_name":"MGMCR","standard_charge_dollar":26446.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":69.00,"standard_charge_algorithm":"Reimbursement will be 69% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veteran's Administration","plan_name":"FEDERAL","standard_charge_dollar":27838.56,"methodology":"fee schedule"}]}]},{"description":"PIN HLF 5X250MM ","code_information":[{"code":"90174","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3636.00,"discounted_cash":3636.00,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":79.10,"standard_charge_algorithm":"Reimbursement will be 79.1% of billable gross 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Healthcare","plan_name":"COMM","standard_charge_percentage":72.30,"standard_charge_algorithm":"Reimbursement will be 72.3% of billable gross charges.","estimated_amount":21.25,"methodology":"percent of total billed charges"},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":64.70,"standard_charge_algorithm":"Reimbursement will be 64.7% of billable gross charges.","estimated_amount":19.02,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":13.31,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":23.51,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":23.51,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":17.63,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":26.45,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":26.45,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":19.10,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"QHP","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":19.10,"methodology":"percent of total billed charges"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":11.61,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":65.70,"standard_charge_algorithm":"Reimbursement will be 65.7% of billable gross charges.","estimated_amount":19.31,"methodology":"percent of total billed charges"}]}]},{"description":"LISINOPRIL 5MG PO ","code_information":[{"code":"643573","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":45.72,"discounted_cash":45.72,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":79.10,"standard_charge_algorithm":"Reimbursement will be 79.1% of billable gross charges.","estimated_amount":36.16,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":43.43,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":18.06,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"POS","standard_charge_percentage":55.90,"standard_charge_algorithm":"Reimbursement will be 55.9% of billable gross charges.","estimated_amount":25.56,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"PPO","standard_charge_percentage":55.90,"standard_charge_algorithm":"Reimbursement will be 55.9% of billable gross charges.","estimated_amount":25.56,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QEP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":43.43,"methodology":"percent of total billed charges"},{"payer_name":"Blue 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Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":41.15,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":41.15,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":36.58,"methodology":"percent of total billed charges"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":38.86,"methodology":"percent of total billed charges"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_percentage":72.30,"standard_charge_algorithm":"Reimbursement will be 72.3% of billable gross charges.","estimated_amount":33.06,"methodology":"percent of total billed charges"},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":64.70,"standard_charge_algorithm":"Reimbursement will be 64.7% of billable gross charges.","estimated_amount":29.58,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":20.71,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":36.58,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":36.58,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":27.43,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":41.15,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus 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charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":65.70,"standard_charge_algorithm":"Reimbursement will be 65.7% of billable gross charges.","estimated_amount":30.04,"methodology":"percent of total billed charges"}]}]},{"description":"LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT ","code_information":[{"code":"005","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":750.00,"maximum":247817.08,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":80.90,"standard_charge_algorithm":"Reimbursement will be 80.9% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_dollar":72000.09,"methodology":"fee schedule"},{"payer_name":"Blue Cross","plan_name":"POS","standard_charge_dollar":215869.95,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"PPO","standard_charge_dollar":215869.95,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"QEP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QHP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"TRAD","standard_charge_dollar":215869.95,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Business Psychology Associates","plan_name":"COMM","standard_charge_dollar":750.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":60.10,"standard_charge_algorithm":"Reimbursement will be 60.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Corizon Health","plan_name":"LOCALGOV","standard_charge_dollar":100140.39,"methodology":"fee schedule"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"EverNorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_dollar":80000.10,"methodology":"fee schedule"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRHMO","standard_charge_dollar":80000.10,"methodology":"fee schedule"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRPPO","standard_charge_dollar":80000.10,"methodology":"fee schedule"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_dollar":170520.49,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $487688.61, reimbursement will be 61.2% of billable gross charges instead of the contracted rate."},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":66.10,"standard_charge_algorithm":"Reimbursement will be 66.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":80000.10,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":62.00,"standard_charge_algorithm":"Reimbursement will be 62% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_dollar":247817.08,"methodology":"fee schedule"},{"payer_name":"St Luke's Health Partners","plan_name":"QHP","standard_charge_dollar":130039.80,"methodology":"fee schedule"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_dollar":72000.09,"methodology":"fee schedule"},{"payer_name":"Veteran's Administration","plan_name":"FEDERAL","standard_charge_dollar":80000.10,"methodology":"fee schedule"}]}]},{"description":"LNR ACTB COC HIP G7D40MM ","code_information":[{"code":"97301","type":"CDM"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":5845.00,"discounted_cash":5845.00,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":79.10,"standard_charge_algorithm":"Reimbursement will be 79.1% of billable gross charges.","estimated_amount":4623.39,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":5552.75,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":2308.78,"methodology":"percent of total billed charges"},{"payer_name":"Blue 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Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":5260.50,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":5260.50,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":4676.00,"methodology":"percent of total billed charges"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":4968.25,"methodology":"percent of total billed charges"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_percentage":72.30,"standard_charge_algorithm":"Reimbursement will be 72.3% of billable gross charges.","estimated_amount":4225.94,"methodology":"percent of total billed charges"},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":64.70,"standard_charge_algorithm":"Reimbursement will be 64.7% of billable gross charges.","estimated_amount":3781.72,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":2647.78,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":4676.00,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":4676.00,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":3507.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":5260.50,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus 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charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":65.70,"standard_charge_algorithm":"Reimbursement will be 65.7% of billable gross charges.","estimated_amount":3840.16,"methodology":"percent of total billed charges"}]}]},{"description":"LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT ","code_information":[{"code":"499","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":750.00,"maximum":28648.76,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":80.90,"standard_charge_algorithm":"Reimbursement will be 80.9% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed 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If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"PPO","standard_charge_dollar":26901.36,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"QEP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QHP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"TRAD","standard_charge_dollar":26901.36,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Business Psychology Associates","plan_name":"COMM","standard_charge_dollar":750.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":60.10,"standard_charge_algorithm":"Reimbursement will be 60.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Corizon Health","plan_name":"LOCALGOV","standard_charge_dollar":10916.27,"methodology":"fee schedule"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"EverNorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_dollar":9938.91,"methodology":"fee schedule"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRHMO","standard_charge_dollar":9938.91,"methodology":"fee schedule"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRPPO","standard_charge_dollar":9938.91,"methodology":"fee schedule"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_dollar":19030.13,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $54426.18, reimbursement will be 61.2% of billable gross charges instead of the contracted rate."},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":66.10,"standard_charge_algorithm":"Reimbursement will be 66.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":9938.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":62.00,"standard_charge_algorithm":"Reimbursement will be 62% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_dollar":28648.76,"methodology":"fee schedule"},{"payer_name":"St Luke's Health Partners","plan_name":"QHP","standard_charge_dollar":15033.18,"methodology":"fee schedule"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_dollar":8945.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":27836.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $199902.00, reimbursement will be $9841 per diem instead of the contracted rate."},{"payer_name":"United  ","plan_name":"MGMCR","standard_charge_dollar":9441.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":69.00,"standard_charge_algorithm":"Reimbursement will be 69% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veteran's Administration","plan_name":"FEDERAL","standard_charge_dollar":9938.91,"methodology":"fee schedule"}]}]},{"description":"LOCM 300-399 IC 15ML ","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"648005","type":"CDM"},{"code":"Q9967","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":54.39,"discounted_cash":54.39,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":79.10,"standard_charge_algorithm":"Reimbursement will be 79.1% of billable gross charges.","estimated_amount":43.02,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":51.67,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":21.48,"methodology":"percent of total billed charges"},{"payer_name":"Blue 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Cross","plan_name":"TRAD","standard_charge_percentage":55.90,"standard_charge_algorithm":"Reimbursement will be 55.9% of billable gross charges.","estimated_amount":30.40,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":58.00,"standard_charge_algorithm":"Reimbursement will be 58% of billable gross charges.","estimated_amount":31.55,"methodology":"percent of total billed charges"},{"payer_name":"Corizon Health","plan_name":"LOCALGOV","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":20.12,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":48.95,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":48.95,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":43.51,"methodology":"percent of total billed charges"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":46.23,"methodology":"percent of total billed charges"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_percentage":72.30,"standard_charge_algorithm":"Reimbursement will be 72.3% of billable gross charges.","estimated_amount":39.32,"methodology":"percent of total billed charges"},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":64.70,"standard_charge_algorithm":"Reimbursement will be 64.7% of billable gross charges.","estimated_amount":35.19,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":24.64,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":43.51,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":43.51,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":32.63,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":48.95,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":48.95,"methodology":"percent of total billed charges"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":21.48,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":65.70,"standard_charge_algorithm":"Reimbursement will be 65.7% of billable gross charges.","estimated_amount":35.73,"methodology":"percent of total billed charges"}]}]},{"description":"LOPERAMIDE 2MG PO ","code_information":[{"code":"642250","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":35.24,"discounted_cash":35.24,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":79.10,"standard_charge_algorithm":"Reimbursement will be 79.1% of billable gross charges.","estimated_amount":27.87,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":33.48,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":13.92,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"POS","standard_charge_percentage":55.90,"standard_charge_algorithm":"Reimbursement will be 55.9% of billable gross charges.","estimated_amount":19.70,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"PPO","standard_charge_percentage":55.90,"standard_charge_algorithm":"Reimbursement will be 55.9% of billable gross charges.","estimated_amount":19.70,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QEP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":33.48,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QHP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":33.48,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"TRAD","standard_charge_percentage":55.90,"standard_charge_algorithm":"Reimbursement will be 55.9% of billable gross charges.","estimated_amount":19.70,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":58.00,"standard_charge_algorithm":"Reimbursement will be 58% of billable gross charges.","estimated_amount":20.44,"methodology":"percent of total billed charges"},{"payer_name":"Corizon Health","plan_name":"LOCALGOV","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":13.04,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":31.72,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":31.72,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":28.19,"methodology":"percent of total billed charges"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":29.95,"methodology":"percent of total billed charges"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_percentage":72.30,"standard_charge_algorithm":"Reimbursement will be 72.3% of billable gross charges.","estimated_amount":25.48,"methodology":"percent of total billed charges"},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":64.70,"standard_charge_algorithm":"Reimbursement will be 64.7% of billable gross charges.","estimated_amount":22.80,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":15.96,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":28.19,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":28.19,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":21.14,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":31.72,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":31.72,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":22.91,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"QHP","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":22.91,"methodology":"percent of total billed charges"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":13.92,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":65.70,"standard_charge_algorithm":"Reimbursement will be 65.7% of billable gross charges.","estimated_amount":23.15,"methodology":"percent of total billed charges"}]}]},{"description":"LORAZEPAM 2 MG INJ ","drug_information":{"unit":"2","type":"ME"},"code_information":[{"code":"647470","type":"CDM"},{"code":"J2060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":14.87,"discounted_cash":14.87,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":79.10,"standard_charge_algorithm":"Reimbursement will be 79.1% of billable gross charges.","estimated_amount":11.76,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":14.13,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":5.87,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"POS","standard_charge_percentage":55.90,"standard_charge_algorithm":"Reimbursement will be 55.9% of billable gross charges.","estimated_amount":8.31,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"PPO","standard_charge_percentage":55.90,"standard_charge_algorithm":"Reimbursement will be 55.9% of billable gross charges.","estimated_amount":8.31,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QEP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":14.13,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QHP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":14.13,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"TRAD","standard_charge_percentage":55.90,"standard_charge_algorithm":"Reimbursement will be 55.9% of billable gross charges.","estimated_amount":8.31,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":58.00,"standard_charge_algorithm":"Reimbursement will be 58% of billable gross charges.","estimated_amount":8.62,"methodology":"percent of total billed charges"},{"payer_name":"Corizon Health","plan_name":"LOCALGOV","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":5.50,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":13.38,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":13.38,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":11.90,"methodology":"percent of total billed charges"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":12.64,"methodology":"percent of total billed charges"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_percentage":72.30,"standard_charge_algorithm":"Reimbursement will be 72.3% of billable gross charges.","estimated_amount":10.75,"methodology":"percent of total billed charges"},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":64.70,"standard_charge_algorithm":"Reimbursement will be 64.7% of billable gross charges.","estimated_amount":9.62,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":6.74,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":11.90,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":11.90,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":8.92,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":13.38,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":13.38,"methodology":"percent of total billed charges"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":5.87,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":65.70,"standard_charge_algorithm":"Reimbursement will be 65.7% of billable gross charges.","estimated_amount":9.77,"methodology":"percent of total billed charges"}]}]},{"description":"LOXAPINE 10MG PO ","code_information":[{"code":"642292","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":41.80,"discounted_cash":41.80,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":79.10,"standard_charge_algorithm":"Reimbursement will be 79.1% of billable gross charges.","estimated_amount":33.06,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":39.71,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":16.51,"methodology":"percent of total billed charges"},{"payer_name":"Blue 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Cross","plan_name":"TRAD","standard_charge_percentage":55.90,"standard_charge_algorithm":"Reimbursement will be 55.9% of billable gross charges.","estimated_amount":23.37,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":58.00,"standard_charge_algorithm":"Reimbursement will be 58% of billable gross charges.","estimated_amount":24.24,"methodology":"percent of total billed charges"},{"payer_name":"Corizon Health","plan_name":"LOCALGOV","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":15.47,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":37.62,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":37.62,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":33.44,"methodology":"percent of total billed charges"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":35.53,"methodology":"percent of total billed charges"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_percentage":72.30,"standard_charge_algorithm":"Reimbursement will be 72.3% of billable gross charges.","estimated_amount":30.22,"methodology":"percent of total billed charges"},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":64.70,"standard_charge_algorithm":"Reimbursement will be 64.7% of billable gross charges.","estimated_amount":27.04,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":18.94,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":33.44,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":33.44,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":25.08,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":37.62,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":37.62,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":27.17,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"QHP","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":27.17,"methodology":"percent of total billed charges"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":16.51,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":65.70,"standard_charge_algorithm":"Reimbursement will be 65.7% of billable gross charges.","estimated_amount":27.46,"methodology":"percent of total billed charges"}]}]},{"description":"LVL 1 EMER DEPT ","code_information":[{"code":"905071","type":"CDM"},{"code":"99281","type":"CPT"}],"standard_charges":[{"setting":"outpatient","gross_charge":706.85,"discounted_cash":706.85,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":79.10,"standard_charge_algorithm":"Reimbursement will be 79.1% of billable gross charges.","estimated_amount":559.12,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":671.51,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":279.21,"methodology":"percent of total billed charges"},{"payer_name":"Blue 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charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":320.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":565.48,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":565.48,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":424.11,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":636.16,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":636.16,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":459.45,"methodology":"percent of total 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Cross","plan_name":"TRAD","standard_charge_percentage":55.90,"standard_charge_algorithm":"Reimbursement will be 55.9% of billable gross charges.","estimated_amount":2453.96,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":58.00,"standard_charge_algorithm":"Reimbursement will be 58% of billable gross charges.","estimated_amount":2546.15,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3950.92,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3950.92,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":3511.93,"methodology":"percent of total billed charges"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3731.42,"methodology":"percent of total billed charges"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_percentage":72.30,"standard_charge_algorithm":"Reimbursement will be 72.3% of billable gross charges.","estimated_amount":3173.90,"methodology":"percent of total billed charges"},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":64.70,"standard_charge_algorithm":"Reimbursement will be 64.7% of billable gross charges.","estimated_amount":2840.27,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":1988.63,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":3511.93,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":3511.93,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":2633.95,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3950.92,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3950.92,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":2853.44,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"QHP","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":2853.44,"methodology":"percent of total billed charges"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":1734.01,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":65.70,"standard_charge_algorithm":"Reimbursement will be 65.7% of billable gross charges.","estimated_amount":2884.17,"methodology":"percent of total billed charges"}]}]},{"description":"LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC ","code_information":[{"code":"824","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":750.00,"maximum":49756.77,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":80.90,"standard_charge_algorithm":"Reimbursement will be 80.9% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_dollar":15846.80,"methodology":"fee schedule"},{"payer_name":"Blue Cross","plan_name":"POS","standard_charge_dollar":46571.60,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"PPO","standard_charge_dollar":46571.60,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"QEP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QHP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"TRAD","standard_charge_dollar":46571.60,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Business Psychology Associates","plan_name":"COMM","standard_charge_dollar":750.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":60.10,"standard_charge_algorithm":"Reimbursement will be 60.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Corizon Health","plan_name":"LOCALGOV","standard_charge_dollar":20682.42,"methodology":"fee schedule"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"EverNorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_dollar":17607.55,"methodology":"fee schedule"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRHMO","standard_charge_dollar":17607.55,"methodology":"fee schedule"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRPPO","standard_charge_dollar":17607.55,"methodology":"fee schedule"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_dollar":38445.53,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $109954.21, reimbursement will be 61.2% of billable gross charges instead of the contracted rate."},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":66.10,"standard_charge_algorithm":"Reimbursement will be 66.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":17607.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":62.00,"standard_charge_algorithm":"Reimbursement will be 62% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_dollar":49756.77,"methodology":"fee schedule"},{"payer_name":"St Luke's Health Partners","plan_name":"QHP","standard_charge_dollar":26109.42,"methodology":"fee schedule"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_dollar":15846.80,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":27836.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $199902.00, reimbursement will be $9841 per diem instead of the contracted rate."},{"payer_name":"United  ","plan_name":"MGMCR","standard_charge_dollar":16727.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":69.00,"standard_charge_algorithm":"Reimbursement will be 69% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veteran's Administration","plan_name":"FEDERAL","standard_charge_dollar":17607.55,"methodology":"fee schedule"}]}]},{"description":"MAG CHL 64MG PO ","code_information":[{"code":"641825","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":21.57,"discounted_cash":21.57,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":79.10,"standard_charge_algorithm":"Reimbursement will be 79.1% of billable gross 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gross charges.","estimated_amount":14.02,"methodology":"percent of total billed charges"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":8.52,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":65.70,"standard_charge_algorithm":"Reimbursement will be 65.7% of billable gross charges.","estimated_amount":14.17,"methodology":"percent of total billed charges"}]}]},{"description":"MAG SULFATE 40G INJ ","drug_information":{"unit":"40","type":"GM"},"code_information":[{"code":"641344","type":"CDM"},{"code":"J3475","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":97.50,"discounted_cash":97.50,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":79.10,"standard_charge_algorithm":"Reimbursement will be 79.1% of billable gross charges.","estimated_amount":77.12,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":92.63,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":38.51,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"POS","standard_charge_percentage":55.90,"standard_charge_algorithm":"Reimbursement will be 55.9% of billable gross charges.","estimated_amount":54.50,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"PPO","standard_charge_percentage":55.90,"standard_charge_algorithm":"Reimbursement will be 55.9% of billable gross 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charges.","estimated_amount":58.50,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":87.75,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":87.75,"methodology":"percent of total billed charges"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":38.51,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":65.70,"standard_charge_algorithm":"Reimbursement will be 65.7% of billable gross charges.","estimated_amount":64.06,"methodology":"percent of total billed charges"}]}]},{"description":"MAJOR BLADDER PROCEDURES WITH MCC ","code_information":[{"code":"653","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":750.00,"maximum":120719.31,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":80.90,"standard_charge_algorithm":"Reimbursement will be 80.9% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_dollar":38276.08,"methodology":"fee schedule"},{"payer_name":"Blue Cross","plan_name":"POS","standard_charge_dollar":112911.46,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"PPO","standard_charge_dollar":112911.46,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"QEP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QHP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"TRAD","standard_charge_dollar":112911.46,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Business Psychology Associates","plan_name":"COMM","standard_charge_dollar":750.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":60.10,"standard_charge_algorithm":"Reimbursement will be 60.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Corizon Health","plan_name":"LOCALGOV","standard_charge_dollar":52420.28,"methodology":"fee schedule"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"EverNorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_dollar":42528.98,"methodology":"fee schedule"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRHMO","standard_charge_dollar":42528.98,"methodology":"fee schedule"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRPPO","standard_charge_dollar":42528.98,"methodology":"fee schedule"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_dollar":91546.03,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $261821.64, reimbursement will be 61.2% of billable gross charges instead of the contracted rate."},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":66.10,"standard_charge_algorithm":"Reimbursement will be 66.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":42528.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":62.00,"standard_charge_algorithm":"Reimbursement will be 62% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_dollar":120719.31,"methodology":"fee schedule"},{"payer_name":"St Luke's Health Partners","plan_name":"QHP","standard_charge_dollar":63346.38,"methodology":"fee schedule"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_dollar":38276.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":27836.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $199902.00, reimbursement will be $9841 per diem instead of the contracted rate."},{"payer_name":"United  ","plan_name":"MGMCR","standard_charge_dollar":40402.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":69.00,"standard_charge_algorithm":"Reimbursement will be 69% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veteran's Administration","plan_name":"FEDERAL","standard_charge_dollar":42528.98,"methodology":"fee schedule"}]}]},{"description":"MAJOR ESOPHAGEAL DISORDERS WITH CC ","code_information":[{"code":"369","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":750.00,"maximum":22205.12,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":80.90,"standard_charge_algorithm":"Reimbursement will be 80.9% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_dollar":7993.32,"methodology":"fee schedule"},{"payer_name":"Blue Cross","plan_name":"POS","standard_charge_dollar":20612.97,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"PPO","standard_charge_dollar":20612.97,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"QEP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QHP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"TRAD","standard_charge_dollar":20612.97,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Business Psychology Associates","plan_name":"COMM","standard_charge_dollar":750.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":60.10,"standard_charge_algorithm":"Reimbursement will be 60.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Corizon Health","plan_name":"LOCALGOV","standard_charge_dollar":9569.60,"methodology":"fee schedule"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"EverNorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_dollar":8881.47,"methodology":"fee schedule"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRHMO","standard_charge_dollar":8881.47,"methodology":"fee schedule"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRPPO","standard_charge_dollar":8881.47,"methodology":"fee schedule"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_dollar":17578.36,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $50274.11, reimbursement will be 61.2% of billable gross charges instead of the contracted rate."},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":66.10,"standard_charge_algorithm":"Reimbursement will be 66.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":8881.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":62.00,"standard_charge_algorithm":"Reimbursement will be 62% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_dollar":22205.12,"methodology":"fee schedule"},{"payer_name":"St Luke's Health Partners","plan_name":"QHP","standard_charge_dollar":11651.94,"methodology":"fee schedule"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_dollar":7993.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":15825.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $199902.00, reimbursement will be $9841 per diem instead of the contracted rate."},{"payer_name":"United  ","plan_name":"MGMCR","standard_charge_dollar":8437.40,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":69.00,"standard_charge_algorithm":"Reimbursement will be 69% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veteran's Administration","plan_name":"FEDERAL","standard_charge_dollar":8881.47,"methodology":"fee schedule"}]}]},{"description":"MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC ","code_information":[{"code":"142","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":750.00,"maximum":36969.43,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":80.90,"standard_charge_algorithm":"Reimbursement will be 80.9% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_dollar":11679.81,"methodology":"fee schedule"},{"payer_name":"Blue Cross","plan_name":"POS","standard_charge_dollar":32224.06,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"PPO","standard_charge_dollar":32224.06,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"QEP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QHP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"TRAD","standard_charge_dollar":32224.06,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Business Psychology Associates","plan_name":"COMM","standard_charge_dollar":750.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":60.10,"standard_charge_algorithm":"Reimbursement will be 60.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Corizon Health","plan_name":"LOCALGOV","standard_charge_dollar":14786.05,"methodology":"fee schedule"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"EverNorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_dollar":12977.57,"methodology":"fee schedule"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRHMO","standard_charge_dollar":12977.57,"methodology":"fee schedule"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRPPO","standard_charge_dollar":12977.57,"methodology":"fee schedule"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_percentage":69.50,"standard_charge_algorithm":"Reimbursement will be 69.5% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":66.10,"standard_charge_algorithm":"Reimbursement will be 66.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":12977.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":62.00,"standard_charge_algorithm":"Reimbursement will be 62% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_dollar":36969.43,"methodology":"fee schedule"},{"payer_name":"St Luke's Health Partners","plan_name":"QHP","standard_charge_dollar":19399.38,"methodology":"fee schedule"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_dollar":11679.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":27836.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $199902.00, reimbursement will be $9841 per diem instead of the contracted rate."},{"payer_name":"United  ","plan_name":"MGMCR","standard_charge_dollar":12328.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":69.00,"standard_charge_algorithm":"Reimbursement will be 69% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veteran's Administration","plan_name":"FEDERAL","standard_charge_dollar":12977.57,"methodology":"fee schedule"}]}]},{"description":"MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC ","code_information":[{"code":"708","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":750.00,"maximum":34088.00,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":80.90,"standard_charge_algorithm":"Reimbursement will be 80.9% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_dollar":11082.34,"methodology":"fee schedule"},{"payer_name":"Blue Cross","plan_name":"POS","standard_charge_dollar":30419.93,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"PPO","standard_charge_dollar":30419.93,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"QEP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QHP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"TRAD","standard_charge_dollar":30419.93,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Business Psychology Associates","plan_name":"COMM","standard_charge_dollar":750.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":60.10,"standard_charge_algorithm":"Reimbursement will be 60.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Corizon Health","plan_name":"LOCALGOV","standard_charge_dollar":13940.62,"methodology":"fee schedule"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"EverNorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_dollar":12313.71,"methodology":"fee schedule"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRHMO","standard_charge_dollar":12313.71,"methodology":"fee schedule"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRPPO","standard_charge_dollar":12313.71,"methodology":"fee schedule"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_dollar":24008.82,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $68665.23, reimbursement will be 61.2% of billable gross charges instead of the contracted rate."},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":66.10,"standard_charge_algorithm":"Reimbursement will be 66.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":12313.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":62.00,"standard_charge_algorithm":"Reimbursement will be 62% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_dollar":32255.11,"methodology":"fee schedule"},{"payer_name":"St Luke's Health Partners","plan_name":"QHP","standard_charge_dollar":16925.58,"methodology":"fee schedule"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_dollar":11082.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":34088.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United  ","plan_name":"MGMCR","standard_charge_dollar":11698.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":69.00,"standard_charge_algorithm":"Reimbursement will be 69% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veteran's Administration","plan_name":"FEDERAL","standard_charge_dollar":12313.71,"methodology":"fee schedule"}]}]},{"description":"MAJOR THUMB OR JOINT PROCEDURES ","code_information":[{"code":"506","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":750.00,"maximum":30627.90,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":80.90,"standard_charge_algorithm":"Reimbursement will be 80.9% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_dollar":11192.66,"methodology":"fee schedule"},{"payer_name":"Blue Cross","plan_name":"POS","standard_charge_dollar":30505.45,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"PPO","standard_charge_dollar":30505.45,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"QEP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QHP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"TRAD","standard_charge_dollar":30505.45,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Business Psychology Associates","plan_name":"COMM","standard_charge_dollar":750.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":60.10,"standard_charge_algorithm":"Reimbursement will be 60.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Corizon Health","plan_name":"LOCALGOV","standard_charge_dollar":14096.73,"methodology":"fee schedule"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"EverNorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_dollar":12436.29,"methodology":"fee schedule"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRHMO","standard_charge_dollar":12436.29,"methodology":"fee schedule"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRPPO","standard_charge_dollar":12436.29,"methodology":"fee schedule"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_dollar":22133.75,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $63302.53, reimbursement will be 61.2% of billable gross charges instead of the contracted rate."},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":66.10,"standard_charge_algorithm":"Reimbursement will be 66.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":12436.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":62.00,"standard_charge_algorithm":"Reimbursement will be 62% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_dollar":30627.90,"methodology":"fee schedule"},{"payer_name":"St Luke's Health Partners","plan_name":"QHP","standard_charge_dollar":16071.72,"methodology":"fee schedule"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_dollar":11192.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":27836.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $199902.00, reimbursement will be $9841 per diem instead of the contracted rate."},{"payer_name":"United  ","plan_name":"MGMCR","standard_charge_dollar":11814.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":69.00,"standard_charge_algorithm":"Reimbursement will be 69% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veteran's Administration","plan_name":"FEDERAL","standard_charge_dollar":12436.29,"methodology":"fee schedule"}]}]},{"description":"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH MCC ","code_information":[{"code":"722","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":750.00,"maximum":39102.70,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":80.90,"standard_charge_algorithm":"Reimbursement will be 80.9% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_dollar":12719.90,"methodology":"fee schedule"},{"payer_name":"Blue Cross","plan_name":"POS","standard_charge_dollar":39102.70,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"PPO","standard_charge_dollar":39102.70,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"QEP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QHP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"TRAD","standard_charge_dollar":39102.70,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Business Psychology Associates","plan_name":"COMM","standard_charge_dollar":750.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":60.10,"standard_charge_algorithm":"Reimbursement will be 60.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Corizon Health","plan_name":"LOCALGOV","standard_charge_dollar":16257.79,"methodology":"fee schedule"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"EverNorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_dollar":14133.22,"methodology":"fee schedule"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRHMO","standard_charge_dollar":14133.22,"methodology":"fee schedule"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRPPO","standard_charge_dollar":14133.22,"methodology":"fee schedule"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_dollar":29844.02,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $85353.90, reimbursement will be 61.2% of billable gross charges instead of the contracted rate."},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":66.10,"standard_charge_algorithm":"Reimbursement will be 66.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":14133.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":62.00,"standard_charge_algorithm":"Reimbursement will be 62% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_dollar":36882.53,"methodology":"fee schedule"},{"payer_name":"St Luke's Health Partners","plan_name":"QHP","standard_charge_dollar":19353.78,"methodology":"fee schedule"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_dollar":12719.90,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":15825.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $199902.00, reimbursement will be $9841 per diem instead of the contracted rate."},{"payer_name":"United  ","plan_name":"MGMCR","standard_charge_dollar":13426.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":69.00,"standard_charge_algorithm":"Reimbursement will be 69% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veteran's Administration","plan_name":"FEDERAL","standard_charge_dollar":14133.22,"methodology":"fee schedule"}]}]},{"description":"MAMMO DIAG CAD UNI RT ","code_information":[{"code":"45995","type":"CDM"},{"code":"77065","type":"CPT"}],"standard_charges":[{"modifiers":"RT","modifiers_description":"Right side (Used to identify procedures performed on the right side of the body)","setting":"outpatient","gross_charge":368.15,"discounted_cash":368.15,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":79.10,"standard_charge_algorithm":"Reimbursement will be 79.1% of billable gross charges.","estimated_amount":291.21,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":349.74,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":145.42,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"POS","standard_charge_percentage":55.90,"standard_charge_algorithm":"Reimbursement will be 55.9% of billable gross 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charges.","estimated_amount":205.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":58.00,"standard_charge_algorithm":"Reimbursement will be 58% of billable gross charges.","estimated_amount":213.53,"methodology":"percent of total billed charges"},{"payer_name":"Corizon Health","plan_name":"LOCALGOV","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":136.22,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":331.33,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":331.33,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":294.52,"methodology":"percent of total billed charges"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":312.93,"methodology":"percent of total billed charges"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_percentage":72.30,"standard_charge_algorithm":"Reimbursement will be 72.3% of billable gross charges.","estimated_amount":266.17,"methodology":"percent of total billed charges"},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":64.70,"standard_charge_algorithm":"Reimbursement will be 64.7% of billable gross charges.","estimated_amount":238.19,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":166.77,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":294.52,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":294.52,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":220.89,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":331.33,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":331.33,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross 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","code_information":[{"code":"85007","type":"CPT"},{"code":"850090","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":73.03,"discounted_cash":73.03,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":79.10,"standard_charge_algorithm":"Reimbursement will be 79.1% of billable gross charges.","estimated_amount":57.77,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":69.38,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":28.85,"methodology":"percent of total billed charges"},{"payer_name":"Blue 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charges"},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":64.70,"standard_charge_algorithm":"Reimbursement will be 64.7% of billable gross charges.","estimated_amount":47.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":33.08,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":58.42,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":58.42,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":43.82,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":65.73,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":65.73,"methodology":"percent of total billed charges"},{"payer_name":"True 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Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":9166.55,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":3811.36,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QEP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":9166.55,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QHP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":9166.55,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":58.00,"standard_charge_algorithm":"Reimbursement will be 58% of billable gross charges.","estimated_amount":5596.42,"methodology":"percent of total billed charges"},{"payer_name":"Corizon Health","plan_name":"LOCALGOV","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":3570.13,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":8684.10,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":8684.10,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":7719.20,"methodology":"percent of total billed charges"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":8201.65,"methodology":"percent of total billed charges"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_percentage":72.30,"standard_charge_algorithm":"Reimbursement will be 72.3% of billable gross charges.","estimated_amount":6976.23,"methodology":"percent of total billed charges"},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":64.70,"standard_charge_algorithm":"Reimbursement will be 64.7% of billable gross charges.","estimated_amount":6242.90,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":4371.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":7719.20,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":7719.20,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":5789.40,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":8684.10,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":8684.10,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":6271.85,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"QHP","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":6271.85,"methodology":"percent of total billed charges"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":3811.36,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":65.70,"standard_charge_algorithm":"Reimbursement will be 65.7% of billable gross charges.","estimated_amount":6339.39,"methodology":"percent of total billed charges"}]}]},{"description":"MASTECTOMY FOR MALIGNANCY WITH CC/MCC ","code_information":[{"code":"582","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":750.00,"maximum":42033.53,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":80.90,"standard_charge_algorithm":"Reimbursement will be 80.9% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_dollar":12868.10,"methodology":"fee schedule"},{"payer_name":"Blue Cross","plan_name":"POS","standard_charge_dollar":36318.29,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"PPO","standard_charge_dollar":36318.29,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Blue Cross","plan_name":"QEP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"QHP","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"TRAD","standard_charge_dollar":36318.29,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges are less than 40% of the negotiated rate, reimbursement will be 95% of billable gross charges. If billable gross charges exceed an amount equal to 4.5 times the negotiated rate, reimbursement shall be 46.5% of billable gross charges instead of the contracted rate"},{"payer_name":"Business Psychology Associates","plan_name":"COMM","standard_charge_dollar":750.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":60.10,"standard_charge_algorithm":"Reimbursement will be 60.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Corizon Health","plan_name":"LOCALGOV","standard_charge_dollar":16467.50,"methodology":"fee schedule"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"EverNorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_dollar":14297.89,"methodology":"fee schedule"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRHMO","standard_charge_dollar":14297.89,"methodology":"fee schedule"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRPPO","standard_charge_dollar":14297.89,"methodology":"fee schedule"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_dollar":26103.80,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $74656.88, reimbursement will be 61.2% of billable gross charges instead of the contracted rate."},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":66.10,"standard_charge_algorithm":"Reimbursement will be 66.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":14297.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":62.00,"standard_charge_algorithm":"Reimbursement will be 62% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_dollar":42033.53,"methodology":"fee schedule"},{"payer_name":"St Luke's Health Partners","plan_name":"QHP","standard_charge_dollar":22056.72,"methodology":"fee schedule"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_dollar":12868.10,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":27836.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $199902.00, reimbursement will be $9841 per diem instead of the contracted rate."},{"payer_name":"United  ","plan_name":"MGMCR","standard_charge_dollar":13583.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":69.00,"standard_charge_algorithm":"Reimbursement will be 69% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veteran's Administration","plan_name":"FEDERAL","standard_charge_dollar":14297.89,"methodology":"fee schedule"}]}]},{"description":"MATRISTEM MICROMATRX 1MG ","drug_information":{"unit":"1","type":"ME"},"code_information":[{"code":"88708","type":"CDM"},{"code":"Q4118","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":21.00,"discounted_cash":21.00,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":79.10,"standard_charge_algorithm":"Reimbursement will be 79.1% of billable gross charges.","estimated_amount":16.61,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"ConnectedCare","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":19.95,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":8.29,"methodology":"percent of total billed charges"},{"payer_name":"Blue 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Cross","plan_name":"TRAD","standard_charge_percentage":55.90,"standard_charge_algorithm":"Reimbursement will be 55.9% of billable gross charges.","estimated_amount":11.74,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":58.00,"standard_charge_algorithm":"Reimbursement will be 58% of billable gross charges.","estimated_amount":12.18,"methodology":"percent of total billed charges"},{"payer_name":"Corizon Health","plan_name":"LOCALGOV","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":7.77,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":18.90,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":18.90,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":16.80,"methodology":"percent of total billed charges"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":17.85,"methodology":"percent of total billed charges"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_percentage":72.30,"standard_charge_algorithm":"Reimbursement will be 72.3% of billable gross charges.","estimated_amount":15.18,"methodology":"percent of total billed charges"},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":64.70,"standard_charge_algorithm":"Reimbursement will be 64.7% of billable gross charges.","estimated_amount":13.59,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":9.51,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":16.80,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":16.80,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":12.60,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":18.90,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":18.90,"methodology":"percent of total billed charges"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":8.29,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":65.70,"standard_charge_algorithm":"Reimbursement will be 65.7% of billable gross charges.","estimated_amount":13.80,"methodology":"percent of total billed charges"}]}]},{"description":"MCATH INFSN 2.6FR 150CM ","code_information":[{"code":"91098","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":22997.00,"discounted_cash":22997.00,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":79.10,"standard_charge_algorithm":"Reimbursement will be 79.1% of billable gross charges.","estimated_amount":18190.63,"methodology":"percent of total billed charges"},{"payer_name":"Blue 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Health","plan_name":"LOCALGOV","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":8508.89,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":20697.30,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":20697.30,"methodology":"percent of total billed charges"},{"payer_name":"Four Rivers Hospice","plan_name":"MCR","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":18397.60,"methodology":"percent of total billed charges"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":19547.45,"methodology":"percent of total billed charges"},{"payer_name":"Intermountain Healthcare","plan_name":"COMM","standard_charge_percentage":72.30,"standard_charge_algorithm":"Reimbursement will be 72.3% of billable gross charges.","estimated_amount":16626.83,"methodology":"percent of total billed charges"},{"payer_name":"Moda","plan_name":"COMM","standard_charge_percentage":64.70,"standard_charge_algorithm":"Reimbursement will be 64.7% of billable gross charges.","estimated_amount":14879.06,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":10417.64,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":18397.60,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":18397.60,"methodology":"percent of total billed charges","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":13798.20,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":20697.30,"methodology":"percent of total billed charges"},{"payer_name":"St Alphonsus Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":20697.30,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"LARGEGROUP","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":14948.05,"methodology":"percent of total billed charges"},{"payer_name":"St Luke's Health Partners","plan_name":"QHP","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":14948.05,"methodology":"percent of total billed charges"},{"payer_name":"True Blue","plan_name":"MCRHMO","standard_charge_percentage":39.50,"standard_charge_algorithm":"Reimbursement will be 39.5% of billable gross charges.","estimated_amount":9083.82,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":65.70,"standard_charge_algorithm":"Reimbursement will be 65.7% of billable gross charges.","estimated_amount":15109.03,"methodology":"percent of total billed charges"}]}]},{"description":"MEDRXYPRGTRN 2.5MG PO ","code_information":[{"code":"647163","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":17.44,"discounted_cash":17.44,"payers_information":[{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":79.10,"standard_charge_algorithm":"Reimbursement will be 79.1% of billable gross charges.","estimated_amount":13.80,"methodology":"percent of total billed charges"},{"payer_name":"Blue 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