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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":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross ","plan_name":"MCR","standard_charge_dollar":13671.07,"methodology":"fee schedule"},{"payer_name":"Blue Cross","plan_name":"POS","standard_charge_dollar":34519.74,"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":34519.74,"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":34519.74,"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":825.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":56.50,"standard_charge_algorithm":"Reimbursement will be 56.5% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":91.00,"standard_charge_algorithm":"Reimbursement will be 91% 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":91.00,"standard_charge_algorithm":"Reimbursement will be 91% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DMBA","plan_name":"HMO","standard_charge_dollar":35997.90,"methodology":"fee schedule"},{"payer_name":"DMBA","plan_name":"PPO","standard_charge_dollar":35997.90,"methodology":"fee schedule"},{"payer_name":"Donor Services","plan_name":"LOCALGOV","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":"Doug Andrus Distributing","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% 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":"First Choice Health Of Washington","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"First Choice of the Midwest","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":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":83.00,"standard_charge_algorithm":"Reimbursement will be 83% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRHMO","standard_charge_dollar":13806.42,"methodology":"fee schedule"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRPPO","standard_charge_dollar":13806.42,"methodology":"fee schedule"},{"payer_name":"Intermountain Healthcare","plan_name":"HIX","standard_charge_dollar":29009.83,"methodology":"fee schedule"},{"payer_name":"Intermountain Healthcare","plan_name":"PPO","standard_charge_dollar":29009.83,"methodology":"fee schedule"},{"payer_name":"Interwest 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":"Interwest Health","plan_name":"WC","standard_charge_dollar":15077.70,"methodology":"fee schedule"},{"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":13535.71,"methodology":"fee schedule"},{"payer_name":"Mountain Health Co-Op","plan_name":"Group","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Mountain Health Co-Op","plan_name":"Individual","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","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":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":84.00,"standard_charge_algorithm":"Reimbursement will be 84% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PacificSource Health","plan_name":"CCNNetworks","standard_charge_dollar":29135.25,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $76043.01, charges over the threshold will be paid at 47.1% of billable gross charges in addition to the contracteded rate."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"GROUPHEALTH","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"INDIGENTCARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"MCR","standard_charge_dollar":13535.71,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WCOMP","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Regence","plan_name":"PPO","standard_charge_dollar":29724.99,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges exceed threshold of $408,240, reimbursement will be 37% of billable gross charges instead of the contracted rate. If billable gross charges exceed threshold of $1,000,000, reimbursement will be 16% of billable gross charges instead of the contracted rate."},{"payer_name":"Rexburg Care and Rehab","plan_name":"COMM","standard_charge_dollar":13535.71,"methodology":"fee schedule"},{"payer_name":"Select Health Idaho (EIRMC only)","plan_name":"HIX","standard_charge_dollar":29007.95,"methodology":"fee schedule"},{"payer_name":"Select Health Idaho (EIRMC only)","plan_name":"PPO","standard_charge_dollar":29007.95,"methodology":"fee schedule"},{"payer_name":"Select Health Idaho (EIRMC only)","plan_name":"SelectMed","standard_charge_dollar":31261.62,"methodology":"fee schedule"},{"payer_name":"Shashone-Bannock Tribal Health","plan_name":"FED","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shashone-Bannock Tribal Health","plan_name":"MCR","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St. John's Health Network","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":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":13535.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":33814.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $399800.00, reimbursement will be $7898 per diem instead of the contracted rate."},{"payer_name":"United  ","plan_name":"MGMCR","standard_charge_dollar":12858.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":69.90,"standard_charge_algorithm":"Reimbursement will be 69.9% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"University of Utah","plan_name":"HIX","standard_charge_dollar":34709.97,"methodology":"fee schedule"},{"payer_name":"University of Utah","plan_name":"HMP","standard_charge_dollar":34709.97,"methodology":"fee schedule"},{"payer_name":"University of Utah","plan_name":"PPO","standard_charge_dollar":34709.97,"methodology":"fee schedule"},{"payer_name":"Value Options","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% 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":13535.71,"methodology":"fee schedule"}]}]},{"description":"MAXIMUM VOLUNTARY VENT ","code_information":[{"code":"670005","type":"CDM"},{"code":"94200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115.00,"maximum":115.00,"gross_charge":259.93,"discounted_cash":259.93,"payers_information":[{"payer_name":"Aetna","plan_name":"CWI","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":116.97,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"IdahoEnvironmentalCoalition","standard_charge_percentage":39.40,"standard_charge_algorithm":"Reimbursement will be 39.4% of billable gross charges.","estimated_amount":102.41,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PEAKPERFERENCE","standard_charge_percentage":48.70,"standard_charge_algorithm":"Reimbursement will be 48.7% of billable gross charges.","estimated_amount":126.59,"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":246.93,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"POS","standard_charge_percentage":57.80,"standard_charge_algorithm":"Reimbursement will be 57.8% of billable gross charges.","estimated_amount":150.24,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"PPO","standard_charge_percentage":57.80,"standard_charge_algorithm":"Reimbursement will be 57.8% of billable gross charges.","estimated_amount":150.24,"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":246.93,"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":246.93,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"TRAD","standard_charge_percentage":57.80,"standard_charge_algorithm":"Reimbursement will be 57.8% of billable gross charges.","estimated_amount":150.24,"methodology":"percent of total billed charges"},{"payer_name":"Business Psychology Associates","plan_name":"COMM","standard_charge_dollar":115.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":56.50,"standard_charge_algorithm":"Reimbursement will be 56.5% of billable gross 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charges.","estimated_amount":173.89,"methodology":"percent of total billed charges"},{"payer_name":"Doug Andrus Distributing","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":103.97,"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":207.94,"methodology":"percent of total billed charges"},{"payer_name":"First Choice Health Of Washington","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":155.96,"methodology":"percent of total billed charges"},{"payer_name":"First Choice of the Midwest","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":233.94,"methodology":"percent of total billed charges"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":207.94,"methodology":"percent of total billed charges"},{"payer_name":"Intermountain Healthcare","plan_name":"HIX","standard_charge_percentage":31.50,"standard_charge_algorithm":"Reimbursement will be 31.5% of billable gross charges.","estimated_amount":81.88,"methodology":"percent of total billed charges"},{"payer_name":"Intermountain Healthcare","plan_name":"PPO","standard_charge_percentage":31.50,"standard_charge_algorithm":"Reimbursement will be 31.5% of billable gross charges.","estimated_amount":81.88,"methodology":"percent of total billed charges"},{"payer_name":"Interwest Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":233.94,"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":117.75,"methodology":"percent of total billed charges"},{"payer_name":"Mountain Health Co-Op","plan_name":"Group","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":194.95,"methodology":"percent of total billed charges"},{"payer_name":"Mountain Health Co-Op","plan_name":"Individual","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":129.97,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross 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Health","plan_name":"MCR","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":259.93,"methodology":"percent of total billed charges"},{"payer_name":"St. John's Health Network","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":233.94,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":63.50,"standard_charge_algorithm":"Reimbursement will be 63.5% of billable gross charges.","estimated_amount":165.06,"methodology":"percent of total billed charges"},{"payer_name":"University of Utah","plan_name":"HIX","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":114.37,"methodology":"percent of total billed charges"},{"payer_name":"University of Utah","plan_name":"HMP","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":114.37,"methodology":"percent of total billed charges"},{"payer_name":"University of Utah","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":114.37,"methodology":"percent of total billed charges"}]}]},{"description":"MCTH PRLD 2.4-3FR 130CM ","code_information":[{"code":"96298","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":115.00,"maximum":115.00,"gross_charge":20226.00,"discounted_cash":20226.00,"payers_information":[{"payer_name":"Aetna","plan_name":"CWI","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":9101.70,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"IdahoEnvironmentalCoalition","standard_charge_percentage":39.40,"standard_charge_algorithm":"Reimbursement will be 39.4% of billable gross charges.","estimated_amount":7969.04,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PEAKPERFERENCE","standard_charge_percentage":48.70,"standard_charge_algorithm":"Reimbursement will be 48.7% of billable gross charges.","estimated_amount":9850.06,"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":19214.70,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"POS","standard_charge_percentage":57.80,"standard_charge_algorithm":"Reimbursement will be 57.8% of billable gross charges.","estimated_amount":11690.63,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"PPO","standard_charge_percentage":57.80,"standard_charge_algorithm":"Reimbursement will be 57.8% of billable gross charges.","estimated_amount":11690.63,"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":19214.70,"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":19214.70,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"TRAD","standard_charge_percentage":57.80,"standard_charge_algorithm":"Reimbursement will be 57.8% of billable gross charges.","estimated_amount":11690.63,"methodology":"percent of total billed charges"},{"payer_name":"Business 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of total billed charges"},{"payer_name":"St. John's Health Network","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":163.43,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":145.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":63.50,"standard_charge_algorithm":"Reimbursement will be 63.5% of billable gross charges.","estimated_amount":115.31,"methodology":"percent of total billed charges"},{"payer_name":"University of Utah","plan_name":"HIX","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":79.90,"methodology":"percent of total billed charges"},{"payer_name":"University of Utah","plan_name":"HMP","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":79.90,"methodology":"percent of total billed charges"},{"payer_name":"University of Utah","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":79.90,"methodology":"percent of total billed charges"}]}]},{"description":"MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC ","code_information":[{"code":"761","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":825.00,"maximum":13811.92,"payers_information":[{"payer_name":"Aetna","plan_name":"CWI","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"IdahoEnvironmentalCoalition","standard_charge_percentage":39.40,"standard_charge_algorithm":"Reimbursement will be 39.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PEAKPERFERENCE","standard_charge_percentage":47.10,"standard_charge_algorithm":"Reimbursement will be 47.1% 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":5742.41,"methodology":"fee schedule"},{"payer_name":"Blue Cross","plan_name":"POS","standard_charge_dollar":13736.22,"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":13736.22,"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":13736.22,"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":825.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":56.50,"standard_charge_algorithm":"Reimbursement will be 56.5% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":91.00,"standard_charge_algorithm":"Reimbursement will be 91% 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":91.00,"standard_charge_algorithm":"Reimbursement will be 91% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DMBA","plan_name":"HMO","standard_charge_dollar":13777.09,"methodology":"fee schedule"},{"payer_name":"DMBA","plan_name":"PPO","standard_charge_dollar":13777.09,"methodology":"fee schedule"},{"payer_name":"Donor Services","plan_name":"LOCALGOV","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":"Doug Andrus Distributing","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% 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":"First Choice Health Of Washington","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"First Choice of the Midwest","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":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":83.00,"standard_charge_algorithm":"Reimbursement will be 83% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRHMO","standard_charge_dollar":5799.26,"methodology":"fee schedule"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRPPO","standard_charge_dollar":5799.26,"methodology":"fee schedule"},{"payer_name":"Intermountain Healthcare","plan_name":"HIX","standard_charge_dollar":11102.62,"methodology":"fee schedule"},{"payer_name":"Intermountain Healthcare","plan_name":"PPO","standard_charge_dollar":11102.62,"methodology":"fee schedule"},{"payer_name":"Interwest 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":"Interwest Health","plan_name":"WC","standard_charge_dollar":5818.50,"methodology":"fee schedule"},{"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":5685.55,"methodology":"fee schedule"},{"payer_name":"Mountain Health Co-Op","plan_name":"Group","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Mountain Health Co-Op","plan_name":"Individual","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","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":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":84.00,"standard_charge_algorithm":"Reimbursement will be 84% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PacificSource Health","plan_name":"CCNNetworks","standard_charge_dollar":11593.61,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $30259.31, charges over the threshold will be paid at 47.1% of billable gross charges in addition to the contracteded rate."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"GROUPHEALTH","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"INDIGENTCARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"MCR","standard_charge_dollar":5685.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WCOMP","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Regence","plan_name":"PPO","standard_charge_dollar":11130.15,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges exceed threshold of $408,240, reimbursement will be 37% of billable gross charges instead of the contracted rate. If billable gross charges exceed threshold of $1,000,000, reimbursement will be 16% of billable gross charges instead of the contracted rate."},{"payer_name":"Rexburg Care and Rehab","plan_name":"COMM","standard_charge_dollar":5685.55,"methodology":"fee schedule"},{"payer_name":"Select Health Idaho (EIRMC only)","plan_name":"HIX","standard_charge_dollar":11117.67,"methodology":"fee schedule"},{"payer_name":"Select Health Idaho (EIRMC only)","plan_name":"PPO","standard_charge_dollar":11117.67,"methodology":"fee schedule"},{"payer_name":"Select Health Idaho (EIRMC only)","plan_name":"SelectMed","standard_charge_dollar":11981.42,"methodology":"fee schedule"},{"payer_name":"Shashone-Bannock Tribal Health","plan_name":"FED","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shashone-Bannock Tribal Health","plan_name":"MCR","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St. John's Health Network","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":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":5685.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11144.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $399800.00, reimbursement will be $7898 per diem instead of the contracted rate."},{"payer_name":"United  ","plan_name":"MGMCR","standard_charge_dollar":5401.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":69.90,"standard_charge_algorithm":"Reimbursement will be 69.9% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"University of Utah","plan_name":"HIX","standard_charge_dollar":13811.92,"methodology":"fee schedule"},{"payer_name":"University of Utah","plan_name":"HMP","standard_charge_dollar":13811.92,"methodology":"fee schedule"},{"payer_name":"University of Utah","plan_name":"PPO","standard_charge_dollar":13811.92,"methodology":"fee schedule"},{"payer_name":"Value Options","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% 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":5685.55,"methodology":"fee schedule"}]}]},{"description":"MEPIVACAIN 1.5% 30ML INJ ","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"645078","type":"CDM"},{"code":"J0670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":115.00,"maximum":115.00,"gross_charge":128.16,"discounted_cash":128.16,"payers_information":[{"payer_name":"Aetna","plan_name":"CWI","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":57.67,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"IdahoEnvironmentalCoalition","standard_charge_percentage":39.40,"standard_charge_algorithm":"Reimbursement will be 39.4% of billable gross 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charges.","estimated_amount":74.08,"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":121.75,"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":121.75,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"TRAD","standard_charge_percentage":57.80,"standard_charge_algorithm":"Reimbursement will be 57.8% of billable gross charges.","estimated_amount":74.08,"methodology":"percent of total billed charges"},{"payer_name":"Business Psychology Associates","plan_name":"COMM","standard_charge_dollar":115.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":56.50,"standard_charge_algorithm":"Reimbursement will be 56.5% of billable gross charges.","estimated_amount":72.41,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":91.00,"standard_charge_algorithm":"Reimbursement will be 91% of billable gross charges.","estimated_amount":116.63,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":91.00,"standard_charge_algorithm":"Reimbursement will be 91% of billable gross charges.","estimated_amount":116.63,"methodology":"percent of total billed charges"},{"payer_name":"DMBA","plan_name":"HMO","standard_charge_percentage":66.90,"standard_charge_algorithm":"Reimbursement will be 66.9% of billable gross charges.","estimated_amount":85.74,"methodology":"percent of total billed charges"},{"payer_name":"DMBA","plan_name":"PPO","standard_charge_percentage":66.90,"standard_charge_algorithm":"Reimbursement will be 66.9% of billable gross charges.","estimated_amount":85.74,"methodology":"percent of total billed charges"},{"payer_name":"Doug Andrus Distributing","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":51.26,"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":102.53,"methodology":"percent of total billed charges"},{"payer_name":"First Choice Health Of Washington","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":76.90,"methodology":"percent of total billed charges"},{"payer_name":"First Choice of the Midwest","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":115.34,"methodology":"percent of total billed charges"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":102.53,"methodology":"percent of total billed charges"},{"payer_name":"Intermountain Healthcare","plan_name":"HIX","standard_charge_percentage":31.50,"standard_charge_algorithm":"Reimbursement will be 31.5% of billable gross charges.","estimated_amount":40.37,"methodology":"percent of total billed charges"},{"payer_name":"Intermountain Healthcare","plan_name":"PPO","standard_charge_percentage":31.50,"standard_charge_algorithm":"Reimbursement will be 31.5% of billable gross charges.","estimated_amount":40.37,"methodology":"percent of total billed charges"},{"payer_name":"Interwest Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":115.34,"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":58.06,"methodology":"percent of total billed charges"},{"payer_name":"Mountain Health Co-Op","plan_name":"Group","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":96.12,"methodology":"percent of total billed charges"},{"payer_name":"Mountain Health Co-Op","plan_name":"Individual","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":64.08,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":115.34,"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":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":84.00,"standard_charge_algorithm":"Reimbursement will be 84% of billable gross charges.","estimated_amount":107.65,"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":"CCNNetworks","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":56.39,"methodology":"percent of total billed charges"},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":70.49,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"GROUPHEALTH","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":108.94,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"INDIGENTCARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":96.12,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WCOMP","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":108.94,"methodology":"percent of total billed charges"},{"payer_name":"Select Health Idaho (EIRMC only)","plan_name":"HIX","standard_charge_percentage":31.50,"standard_charge_algorithm":"Reimbursement will be 31.5% of billable gross charges.","estimated_amount":40.37,"methodology":"percent of total billed charges"},{"payer_name":"Select Health Idaho (EIRMC only)","plan_name":"PPO","standard_charge_percentage":31.50,"standard_charge_algorithm":"Reimbursement will be 31.5% of billable gross charges.","estimated_amount":40.37,"methodology":"percent of total billed charges"},{"payer_name":"Select Health Idaho (EIRMC only)","plan_name":"SelectMed","standard_charge_percentage":35.10,"standard_charge_algorithm":"Reimbursement will be 35.1% of billable gross charges.","estimated_amount":44.98,"methodology":"percent of total billed charges"},{"payer_name":"Shashone-Bannock Tribal Health","plan_name":"FED","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross 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gross charges.","estimated_amount":56.39,"methodology":"percent of total billed charges"},{"payer_name":"University of Utah","plan_name":"HMP","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":56.39,"methodology":"percent of total billed charges"},{"payer_name":"University of Utah","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":56.39,"methodology":"percent of total billed charges"}]}]},{"description":"MEROPENEM 20 MG/ML INJ 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charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":9156.09,"methodology":"fee schedule"},{"payer_name":"Mountain Health Co-Op","plan_name":"Group","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Mountain Health Co-Op","plan_name":"Individual","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","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":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":84.00,"standard_charge_algorithm":"Reimbursement will be 84% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PacificSource Health","plan_name":"CCNNetworks","standard_charge_dollar":20323.27,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $53043.74, charges over the threshold will be paid at 47.1% of billable gross charges in addition to the contracteded rate."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"GROUPHEALTH","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"INDIGENTCARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"MCR","standard_charge_dollar":9156.09,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WCOMP","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Regence","plan_name":"PPO","standard_charge_dollar":22167.82,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges exceed threshold of $408,240, reimbursement will be 37% of billable gross charges instead of the contracted rate. If billable gross charges exceed threshold of $1,000,000, reimbursement will be 16% of billable gross charges instead of the contracted rate."},{"payer_name":"Rexburg Care and Rehab","plan_name":"COMM","standard_charge_dollar":9156.09,"methodology":"fee schedule"},{"payer_name":"Select Health Idaho (EIRMC only)","plan_name":"HIX","standard_charge_dollar":22276.75,"methodology":"fee schedule"},{"payer_name":"Select Health Idaho (EIRMC only)","plan_name":"PPO","standard_charge_dollar":22276.75,"methodology":"fee schedule"},{"payer_name":"Select Health Idaho (EIRMC only)","plan_name":"SelectMed","standard_charge_dollar":24007.46,"methodology":"fee schedule"},{"payer_name":"Shashone-Bannock Tribal Health","plan_name":"FED","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shashone-Bannock Tribal Health","plan_name":"MCR","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St. John's Health Network","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":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":9156.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":33814.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $399800.00, reimbursement will be $7898 per diem instead of the contracted rate."},{"payer_name":"United  ","plan_name":"MGMCR","standard_charge_dollar":8698.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":69.90,"standard_charge_algorithm":"Reimbursement will be 69.9% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"University of Utah","plan_name":"HIX","standard_charge_dollar":24211.91,"methodology":"fee schedule"},{"payer_name":"University of Utah","plan_name":"HMP","standard_charge_dollar":24211.91,"methodology":"fee schedule"},{"payer_name":"University of Utah","plan_name":"PPO","standard_charge_dollar":24211.91,"methodology":"fee schedule"},{"payer_name":"Value Options","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% 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":9156.09,"methodology":"fee schedule"}]}]},{"description":"MIRTAZAPINE 15MG PO ","code_information":[{"code":"643758","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":115.00,"maximum":115.00,"gross_charge":63.87,"discounted_cash":63.87,"payers_information":[{"payer_name":"Aetna","plan_name":"CWI","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":28.74,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"IdahoEnvironmentalCoalition","standard_charge_percentage":39.40,"standard_charge_algorithm":"Reimbursement will be 39.4% of billable gross charges.","estimated_amount":25.16,"methodology":"percent of total billed 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","drug_information":{"unit":"200","type":"GM"},"code_information":[{"code":"640418","type":"CDM"},{"code":"S0191","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":115.00,"maximum":115.00,"gross_charge":19.35,"discounted_cash":19.35,"payers_information":[{"payer_name":"Aetna","plan_name":"CWI","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":8.71,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"IdahoEnvironmentalCoalition","standard_charge_percentage":39.40,"standard_charge_algorithm":"Reimbursement will be 39.4% of billable gross charges.","estimated_amount":7.62,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PEAKPERFERENCE","standard_charge_percentage":48.70,"standard_charge_algorithm":"Reimbursement will be 48.7% of billable gross charges.","estimated_amount":9.42,"methodology":"percent of total billed 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logic."},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":84.00,"standard_charge_algorithm":"Reimbursement will be 84% of billable gross charges.","estimated_amount":16.25,"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":"CCNNetworks","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":8.51,"methodology":"percent of total billed charges"},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":10.64,"methodology":"percent of total billed charges"},{"payer_name":"Prime 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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":33421.93,"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":33421.93,"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":825.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":56.50,"standard_charge_algorithm":"Reimbursement will be 56.5% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":91.00,"standard_charge_algorithm":"Reimbursement will be 91% 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":91.00,"standard_charge_algorithm":"Reimbursement will be 91% of billable gross 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charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"First Choice Health Of Washington","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"First Choice of the Midwest","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":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":83.00,"standard_charge_algorithm":"Reimbursement will be 83% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRHMO","standard_charge_dollar":12667.98,"methodology":"fee schedule"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRPPO","standard_charge_dollar":12667.98,"methodology":"fee schedule"},{"payer_name":"Intermountain Healthcare","plan_name":"HIX","standard_charge_dollar":25701.62,"methodology":"fee schedule"},{"payer_name":"Intermountain Healthcare","plan_name":"PPO","standard_charge_dollar":25701.62,"methodology":"fee schedule"},{"payer_name":"Interwest 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":"Interwest Health","plan_name":"WC","standard_charge_dollar":13761.00,"methodology":"fee schedule"},{"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":12419.59,"methodology":"fee schedule"},{"payer_name":"Mountain Health Co-Op","plan_name":"Group","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Mountain Health Co-Op","plan_name":"Individual","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","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":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":84.00,"standard_charge_algorithm":"Reimbursement will be 84% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PacificSource Health","plan_name":"CCNNetworks","standard_charge_dollar":28208.68,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $73624.67, charges over the threshold will be paid at 47.1% of billable gross charges in addition to the contracteded rate."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"GROUPHEALTH","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross 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Health","plan_name":"FED","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shashone-Bannock Tribal Health","plan_name":"MCR","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St. John's Health Network","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":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":12419.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11144.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $399800.00, reimbursement will be $7898 per diem instead of the contracted rate."},{"payer_name":"United  ","plan_name":"MGMCR","standard_charge_dollar":11798.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":69.90,"standard_charge_algorithm":"Reimbursement will be 69.9% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"University of Utah","plan_name":"HIX","standard_charge_dollar":33606.11,"methodology":"fee schedule"},{"payer_name":"University of Utah","plan_name":"HMP","standard_charge_dollar":33606.11,"methodology":"fee schedule"},{"payer_name":"University of Utah","plan_name":"PPO","standard_charge_dollar":33606.11,"methodology":"fee schedule"},{"payer_name":"Value Options","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross 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charges"},{"payer_name":"Business Psychology Associates","plan_name":"COMM","standard_charge_dollar":115.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":56.50,"standard_charge_algorithm":"Reimbursement will be 56.5% of billable gross charges.","estimated_amount":611.89,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":91.00,"standard_charge_algorithm":"Reimbursement will be 91% of billable gross charges.","estimated_amount":985.53,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":91.00,"standard_charge_algorithm":"Reimbursement will be 91% of billable gross charges.","estimated_amount":985.53,"methodology":"percent of total billed charges"},{"payer_name":"DMBA","plan_name":"HMO","standard_charge_percentage":66.90,"standard_charge_algorithm":"Reimbursement will be 66.9% 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billable gross charges.","estimated_amount":649.80,"methodology":"percent of total billed charges"},{"payer_name":"First Choice of the Midwest","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":974.70,"methodology":"percent of total billed charges"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":866.40,"methodology":"percent of total billed charges"},{"payer_name":"Intermountain Healthcare","plan_name":"HIX","standard_charge_percentage":31.50,"standard_charge_algorithm":"Reimbursement will be 31.5% of billable gross charges.","estimated_amount":341.14,"methodology":"percent of total billed charges"},{"payer_name":"Intermountain Healthcare","plan_name":"PPO","standard_charge_percentage":31.50,"standard_charge_algorithm":"Reimbursement will be 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charges.","estimated_amount":154.37,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"WCOMP","standard_charge_percentage":91.00,"standard_charge_algorithm":"Reimbursement will be 91% of billable gross charges.","estimated_amount":154.37,"methodology":"percent of total billed charges"},{"payer_name":"DMBA","plan_name":"HMO","standard_charge_percentage":66.90,"standard_charge_algorithm":"Reimbursement will be 66.9% of billable gross charges.","estimated_amount":113.49,"methodology":"percent of total billed charges"},{"payer_name":"DMBA","plan_name":"PPO","standard_charge_percentage":66.90,"standard_charge_algorithm":"Reimbursement will be 66.9% of billable gross charges.","estimated_amount":113.49,"methodology":"percent of total billed charges"},{"payer_name":"Doug Andrus Distributing","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross 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charges.","estimated_amount":135.71,"methodology":"percent of total billed charges"},{"payer_name":"Intermountain Healthcare","plan_name":"HIX","standard_charge_percentage":31.50,"standard_charge_algorithm":"Reimbursement will be 31.5% of billable gross charges.","estimated_amount":53.44,"methodology":"percent of total billed charges"},{"payer_name":"Intermountain Healthcare","plan_name":"PPO","standard_charge_percentage":31.50,"standard_charge_algorithm":"Reimbursement will be 31.5% of billable gross charges.","estimated_amount":53.44,"methodology":"percent of total billed charges"},{"payer_name":"Interwest Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":152.68,"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":76.85,"methodology":"percent of total billed charges"},{"payer_name":"Mountain Health Co-Op","plan_name":"Group","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":127.23,"methodology":"percent of total billed charges"},{"payer_name":"Mountain Health Co-Op","plan_name":"Individual","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":84.82,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":152.68,"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":84.00,"standard_charge_algorithm":"Reimbursement will be 84% of billable gross charges.","estimated_amount":142.50,"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":"CCNNetworks","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":74.64,"methodology":"percent of total billed charges"},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":93.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"GROUPHEALTH","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":144.19,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"INDIGENTCARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":127.23,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WCOMP","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":144.19,"methodology":"percent of total billed charges"},{"payer_name":"Select Health Idaho (EIRMC only)","plan_name":"HIX","standard_charge_percentage":31.50,"standard_charge_algorithm":"Reimbursement will be 31.5% of billable gross charges.","estimated_amount":53.44,"methodology":"percent of total billed charges"},{"payer_name":"Select Health Idaho (EIRMC only)","plan_name":"PPO","standard_charge_percentage":31.50,"standard_charge_algorithm":"Reimbursement will be 31.5% of billable gross charges.","estimated_amount":53.44,"methodology":"percent of total billed charges"},{"payer_name":"Select Health Idaho (EIRMC only)","plan_name":"SelectMed","standard_charge_percentage":35.10,"standard_charge_algorithm":"Reimbursement will be 35.1% of billable gross charges.","estimated_amount":59.54,"methodology":"percent of total billed charges"},{"payer_name":"Shashone-Bannock Tribal Health","plan_name":"FED","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":169.64,"methodology":"percent of total billed charges"},{"payer_name":"Shashone-Bannock Tribal Health","plan_name":"MCR","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":169.64,"methodology":"percent of total billed charges"},{"payer_name":"St. John's Health Network","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":152.68,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":63.50,"standard_charge_algorithm":"Reimbursement will be 63.5% of billable gross charges.","estimated_amount":107.72,"methodology":"percent of total billed charges"},{"payer_name":"University of Utah","plan_name":"HIX","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":74.64,"methodology":"percent of total billed charges"},{"payer_name":"University of Utah","plan_name":"HMP","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":74.64,"methodology":"percent of total billed charges"},{"payer_name":"University of Utah","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":74.64,"methodology":"percent of total billed charges"}]}]},{"description":"NEUROSES EXCEPT DEPRESSIVE ","code_information":[{"code":"882","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":825.00,"maximum":21305.20,"payers_information":[{"payer_name":"Aetna","plan_name":"CWI","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"IdahoEnvironmentalCoalition","standard_charge_percentage":39.40,"standard_charge_algorithm":"Reimbursement will be 39.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PEAKPERFERENCE","standard_charge_percentage":47.10,"standard_charge_algorithm":"Reimbursement will be 47.1% 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":8320.83,"methodology":"fee schedule"},{"payer_name":"Blue Cross","plan_name":"POS","standard_charge_dollar":21305.20,"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":21305.20,"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":6846.21,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"TRAD","standard_charge_dollar":21305.20,"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":825.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":56.50,"standard_charge_algorithm":"Reimbursement will be 56.5% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":91.00,"standard_charge_algorithm":"Reimbursement will be 91% 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":91.00,"standard_charge_algorithm":"Reimbursement will be 91% of billable gross 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rate","additional_payer_notes":" If billable gross charges exceed threshold of $46932.91, charges over the threshold will be paid at 47.1% of billable gross charges in addition to the contracteded rate."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"GROUPHEALTH","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"INDIGENTCARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"MCR","standard_charge_dollar":8238.45,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WCOMP","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Regence","plan_name":"PPO","standard_charge_dollar":1681.00,"methodology":"per diem"},{"payer_name":"Rexburg Care and Rehab","plan_name":"COMM","standard_charge_dollar":8238.45,"methodology":"fee schedule"},{"payer_name":"Select Health Idaho (EIRMC only)","plan_name":"HIX","standard_charge_dollar":1266.00,"methodology":"per diem"},{"payer_name":"Select Health Idaho (EIRMC only)","plan_name":"PPO","standard_charge_dollar":1266.00,"methodology":"per diem"},{"payer_name":"Select Health Idaho (EIRMC only)","plan_name":"SelectMed","standard_charge_dollar":1302.00,"methodology":"per diem"},{"payer_name":"Shashone-Bannock Tribal Health","plan_name":"FED","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shashone-Bannock Tribal Health","plan_name":"MCR","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St. John's Health Network","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":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":8238.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11144.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $399800.00, reimbursement will be $7898 per diem instead of the contracted rate."},{"payer_name":"United  ","plan_name":"MGMCR","standard_charge_dollar":7826.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":69.90,"standard_charge_algorithm":"Reimbursement will be 69.9% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"University of Utah","plan_name":"HIX","standard_charge_dollar":1832.00,"methodology":"per diem"},{"payer_name":"University of Utah","plan_name":"HMP","standard_charge_dollar":1832.00,"methodology":"per diem"},{"payer_name":"University of Utah","plan_name":"PPO","standard_charge_dollar":1832.00,"methodology":"per diem"},{"payer_name":"Veteran's Administration","plan_name":"FEDERAL","standard_charge_dollar":8238.45,"methodology":"fee schedule"}]}]},{"description":"NEWBORN METABOLIC SCR ","code_information":[{"code":"221516","type":"CDM"},{"code":"S3620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":115.00,"maximum":115.00,"gross_charge":146.05,"discounted_cash":146.05,"payers_information":[{"payer_name":"Aetna","plan_name":"CWI","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":65.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"IdahoEnvironmentalCoalition","standard_charge_percentage":39.40,"standard_charge_algorithm":"Reimbursement will be 39.4% of billable gross charges.","estimated_amount":57.54,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PEAKPERFERENCE","standard_charge_percentage":48.70,"standard_charge_algorithm":"Reimbursement will be 48.7% of billable gross charges.","estimated_amount":71.13,"methodology":"percent of total billed charges"},{"payer_name":"Blue 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charges"},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":1683.76,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"GROUPHEALTH","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2602.17,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"INDIGENTCARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":2296.03,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WCOMP","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2602.17,"methodology":"percent of total billed charges"},{"payer_name":"Select Health Idaho (EIRMC only)","plan_name":"HIX","standard_charge_percentage":31.50,"standard_charge_algorithm":"Reimbursement will be 31.5% of billable gross charges.","estimated_amount":964.33,"methodology":"percent of total billed charges"},{"payer_name":"Select Health Idaho (EIRMC only)","plan_name":"PPO","standard_charge_percentage":31.50,"standard_charge_algorithm":"Reimbursement will be 31.5% of billable gross charges.","estimated_amount":964.33,"methodology":"percent of total billed charges"},{"payer_name":"Select Health Idaho (EIRMC only)","plan_name":"SelectMed","standard_charge_percentage":35.10,"standard_charge_algorithm":"Reimbursement will be 35.1% of billable gross charges.","estimated_amount":1074.54,"methodology":"percent of total billed charges"},{"payer_name":"Shashone-Bannock Tribal Health","plan_name":"FED","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":3061.38,"methodology":"percent of total billed charges"},{"payer_name":"Shashone-Bannock Tribal Health","plan_name":"MCR","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":3061.38,"methodology":"percent of total billed charges"},{"payer_name":"St. John's Health Network","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2755.24,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":63.50,"standard_charge_algorithm":"Reimbursement will be 63.5% of billable gross charges.","estimated_amount":1943.98,"methodology":"percent of total billed charges"},{"payer_name":"University of Utah","plan_name":"HIX","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":1347.01,"methodology":"percent of total billed charges"},{"payer_name":"University of Utah","plan_name":"HMP","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":1347.01,"methodology":"percent of total billed charges"},{"payer_name":"University of Utah","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":1347.01,"methodology":"percent of total billed charges"}]}]},{"description":"NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC ","code_information":[{"code":"098","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":825.00,"maximum":49291.63,"payers_information":[{"payer_name":"Aetna","plan_name":"CWI","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"IdahoEnvironmentalCoalition","standard_charge_percentage":39.40,"standard_charge_algorithm":"Reimbursement will be 39.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PEAKPERFERENCE","standard_charge_percentage":47.10,"standard_charge_algorithm":"Reimbursement will be 47.1% 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":17810.69,"methodology":"fee schedule"},{"payer_name":"Blue Cross","plan_name":"POS","standard_charge_dollar":48868.37,"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":48868.37,"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":48868.37,"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":825.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":56.50,"standard_charge_algorithm":"Reimbursement will be 56.5% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":91.00,"standard_charge_algorithm":"Reimbursement will be 91% 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":91.00,"standard_charge_algorithm":"Reimbursement will be 91% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DMBA","plan_name":"HMO","standard_charge_dollar":49291.63,"methodology":"fee schedule"},{"payer_name":"DMBA","plan_name":"PPO","standard_charge_dollar":49291.63,"methodology":"fee schedule"},{"payer_name":"Donor Services","plan_name":"LOCALGOV","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":"Doug Andrus Distributing","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% 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":"First Choice Health Of Washington","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"First Choice of the Midwest","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":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":83.00,"standard_charge_algorithm":"Reimbursement will be 83% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRHMO","standard_charge_dollar":17987.04,"methodology":"fee schedule"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRPPO","standard_charge_dollar":17987.04,"methodology":"fee schedule"},{"payer_name":"Intermountain Healthcare","plan_name":"HIX","standard_charge_dollar":39722.92,"methodology":"fee schedule"},{"payer_name":"Intermountain Healthcare","plan_name":"PPO","standard_charge_dollar":39722.92,"methodology":"fee schedule"},{"payer_name":"Interwest 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":"Interwest Health","plan_name":"WC","standard_charge_dollar":19911.60,"methodology":"fee schedule"},{"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":17634.35,"methodology":"fee schedule"},{"payer_name":"Mountain Health Co-Op","plan_name":"Group","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Mountain Health Co-Op","plan_name":"Individual","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","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":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":84.00,"standard_charge_algorithm":"Reimbursement will be 84% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PacificSource Health","plan_name":"CCNNetworks","standard_charge_dollar":41245.75,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $107651.40, charges over the threshold will be paid at 47.1% of billable gross charges in addition to the contracteded rate."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"GROUPHEALTH","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"INDIGENTCARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"MCR","standard_charge_dollar":17634.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WCOMP","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Regence","plan_name":"PPO","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Rexburg Care and Rehab","plan_name":"COMM","standard_charge_dollar":17634.35,"methodology":"fee schedule"},{"payer_name":"Select Health Idaho (EIRMC only)","plan_name":"HIX","standard_charge_percentage":31.50,"standard_charge_algorithm":"Reimbursement will be 31.5% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Select Health Idaho (EIRMC only)","plan_name":"PPO","standard_charge_percentage":31.50,"standard_charge_algorithm":"Reimbursement will be 31.5% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Select Health Idaho (EIRMC only)","plan_name":"SelectMed","standard_charge_percentage":35.10,"standard_charge_algorithm":"Reimbursement will be 35.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shashone-Bannock Tribal Health","plan_name":"FED","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shashone-Bannock Tribal Health","plan_name":"MCR","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St. John's Health Network","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":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":17634.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11144.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $399800.00, reimbursement will be $7898 per diem instead of the contracted rate."},{"payer_name":"United  ","plan_name":"MGMCR","standard_charge_dollar":16752.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":69.90,"standard_charge_algorithm":"Reimbursement will be 69.9% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"University of Utah","plan_name":"HIX","standard_charge_dollar":49137.68,"methodology":"fee schedule"},{"payer_name":"University of Utah","plan_name":"HMP","standard_charge_dollar":49137.68,"methodology":"fee schedule"},{"payer_name":"University of Utah","plan_name":"PPO","standard_charge_dollar":49137.68,"methodology":"fee schedule"},{"payer_name":"Value Options","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% 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":17634.35,"methodology":"fee schedule"}]}]},{"description":"NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC ","code_information":[{"code":"601","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":825.00,"maximum":16056.15,"payers_information":[{"payer_name":"Aetna","plan_name":"CWI","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"IdahoEnvironmentalCoalition","standard_charge_percentage":39.40,"standard_charge_algorithm":"Reimbursement will be 39.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PEAKPERFERENCE","standard_charge_percentage":47.10,"standard_charge_algorithm":"Reimbursement will be 47.1% 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":5471.99,"methodology":"fee schedule"},{"payer_name":"Blue Cross","plan_name":"POS","standard_charge_dollar":14369.05,"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":14369.05,"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":14369.05,"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":825.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":56.50,"standard_charge_algorithm":"Reimbursement will be 56.5% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":91.00,"standard_charge_algorithm":"Reimbursement will be 91% 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":91.00,"standard_charge_algorithm":"Reimbursement will be 91% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DMBA","plan_name":"HMO","standard_charge_dollar":16056.15,"methodology":"fee schedule"},{"payer_name":"DMBA","plan_name":"PPO","standard_charge_dollar":16056.15,"methodology":"fee schedule"},{"payer_name":"Donor Services","plan_name":"LOCALGOV","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":"Doug Andrus Distributing","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% 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":"First Choice Health Of Washington","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"First Choice of the Midwest","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":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":83.00,"standard_charge_algorithm":"Reimbursement will be 83% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRHMO","standard_charge_dollar":5526.17,"methodology":"fee schedule"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRPPO","standard_charge_dollar":5526.17,"methodology":"fee schedule"},{"payer_name":"Intermountain Healthcare","plan_name":"HIX","standard_charge_dollar":12939.26,"methodology":"fee schedule"},{"payer_name":"Intermountain Healthcare","plan_name":"PPO","standard_charge_dollar":12939.26,"methodology":"fee schedule"},{"payer_name":"Interwest 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":"Interwest Health","plan_name":"WC","standard_charge_dollar":5502.60,"methodology":"fee schedule"},{"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":5417.81,"methodology":"fee schedule"},{"payer_name":"Mountain Health Co-Op","plan_name":"Group","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Mountain Health Co-Op","plan_name":"Individual","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","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":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":84.00,"standard_charge_algorithm":"Reimbursement will be 84% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PacificSource Health","plan_name":"CCNNetworks","standard_charge_dollar":12127.72,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $31653.36, charges over the threshold will be paid at 47.1% of billable gross charges in addition to the contracteded rate."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"GROUPHEALTH","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"INDIGENTCARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"MCR","standard_charge_dollar":5417.81,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WCOMP","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Regence","plan_name":"PPO","standard_charge_dollar":13849.23,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges exceed threshold of $408,240, reimbursement will be 37% of billable gross charges instead of the contracted rate. If billable gross charges exceed threshold of $1,000,000, reimbursement will be 16% of billable gross charges instead of the contracted rate."},{"payer_name":"Rexburg Care and Rehab","plan_name":"COMM","standard_charge_dollar":5417.81,"methodology":"fee schedule"},{"payer_name":"Select Health Idaho (EIRMC only)","plan_name":"HIX","standard_charge_dollar":12924.20,"methodology":"fee schedule"},{"payer_name":"Select Health Idaho (EIRMC only)","plan_name":"PPO","standard_charge_dollar":12924.20,"methodology":"fee schedule"},{"payer_name":"Select Health Idaho (EIRMC only)","plan_name":"SelectMed","standard_charge_dollar":13928.30,"methodology":"fee schedule"},{"payer_name":"Shashone-Bannock Tribal Health","plan_name":"FED","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shashone-Bannock Tribal Health","plan_name":"MCR","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St. John's Health Network","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":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":5417.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11144.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $399800.00, reimbursement will be $7898 per diem instead of the contracted rate."},{"payer_name":"United  ","plan_name":"MGMCR","standard_charge_dollar":5146.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":69.90,"standard_charge_algorithm":"Reimbursement will be 69.9% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"University of Utah","plan_name":"HIX","standard_charge_dollar":14448.23,"methodology":"fee schedule"},{"payer_name":"University of Utah","plan_name":"HMP","standard_charge_dollar":14448.23,"methodology":"fee schedule"},{"payer_name":"University of Utah","plan_name":"PPO","standard_charge_dollar":14448.23,"methodology":"fee schedule"},{"payer_name":"Value Options","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross 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logic."},{"payer_name":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":84.00,"standard_charge_algorithm":"Reimbursement will be 84% of billable gross charges.","estimated_amount":5.64,"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":"CCNNetworks","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":2.96,"methodology":"percent of total billed charges"},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":3.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime 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charges"},{"payer_name":"Select Health Idaho (EIRMC only)","plan_name":"PPO","standard_charge_percentage":31.50,"standard_charge_algorithm":"Reimbursement will be 31.5% of billable gross charges.","estimated_amount":16.20,"methodology":"percent of total billed charges"},{"payer_name":"Select Health Idaho (EIRMC only)","plan_name":"SelectMed","standard_charge_percentage":35.10,"standard_charge_algorithm":"Reimbursement will be 35.1% of billable gross charges.","estimated_amount":18.06,"methodology":"percent of total billed charges"},{"payer_name":"Shashone-Bannock Tribal Health","plan_name":"FED","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":51.44,"methodology":"percent of total billed charges"},{"payer_name":"Shashone-Bannock Tribal Health","plan_name":"MCR","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":51.44,"methodology":"percent of total billed charges"},{"payer_name":"St. John's Health Network","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":46.30,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":63.50,"standard_charge_algorithm":"Reimbursement will be 63.5% of billable gross charges.","estimated_amount":32.66,"methodology":"percent of total billed charges"},{"payer_name":"University of Utah","plan_name":"HIX","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":22.63,"methodology":"percent of total billed charges"},{"payer_name":"University of Utah","plan_name":"HMP","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":22.63,"methodology":"percent of total billed charges"},{"payer_name":"University of Utah","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":22.63,"methodology":"percent of total billed charges"}]}]},{"description":"RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC ","code_information":[{"code":"177","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":825.00,"maximum":43089.60,"payers_information":[{"payer_name":"Aetna","plan_name":"CWI","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"IdahoEnvironmentalCoalition","standard_charge_percentage":39.40,"standard_charge_algorithm":"Reimbursement will be 39.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PEAKPERFERENCE","standard_charge_percentage":47.10,"standard_charge_algorithm":"Reimbursement will be 47.1% 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":13466.67,"methodology":"fee schedule"},{"payer_name":"Blue Cross","plan_name":"POS","standard_charge_dollar":38477.74,"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":38477.74,"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":38477.74,"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":825.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":56.50,"standard_charge_algorithm":"Reimbursement will be 56.5% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":91.00,"standard_charge_algorithm":"Reimbursement will be 91% 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":91.00,"standard_charge_algorithm":"Reimbursement will be 91% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DMBA","plan_name":"HMO","standard_charge_dollar":43089.60,"methodology":"fee schedule"},{"payer_name":"DMBA","plan_name":"PPO","standard_charge_dollar":43089.60,"methodology":"fee schedule"},{"payer_name":"Donor Services","plan_name":"LOCALGOV","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":"Doug Andrus Distributing","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% 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":"First Choice Health Of Washington","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"First Choice of the Midwest","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":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":83.00,"standard_charge_algorithm":"Reimbursement will be 83% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRHMO","standard_charge_dollar":13600.01,"methodology":"fee schedule"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRPPO","standard_charge_dollar":13600.01,"methodology":"fee schedule"},{"payer_name":"Intermountain Healthcare","plan_name":"HIX","standard_charge_dollar":34724.86,"methodology":"fee schedule"},{"payer_name":"Intermountain Healthcare","plan_name":"PPO","standard_charge_dollar":34724.86,"methodology":"fee schedule"},{"payer_name":"Interwest 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":"Interwest Health","plan_name":"WC","standard_charge_dollar":14839.20,"methodology":"fee schedule"},{"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":13333.34,"methodology":"fee schedule"},{"payer_name":"Mountain Health Co-Op","plan_name":"Group","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Mountain Health Co-Op","plan_name":"Individual","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","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":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":84.00,"standard_charge_algorithm":"Reimbursement will be 84% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PacificSource Health","plan_name":"CCNNetworks","standard_charge_dollar":32475.88,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $84762.05, charges over the threshold will be paid at 47.1% of billable gross charges in addition to the contracteded rate."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"GROUPHEALTH","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"INDIGENTCARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"MCR","standard_charge_dollar":13333.34,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WCOMP","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Regence","plan_name":"PPO","standard_charge_dollar":35019.53,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges exceed threshold of $408,240, reimbursement will be 37% of billable gross charges instead of the contracted rate. If billable gross charges exceed threshold of $1,000,000, reimbursement will be 16% of billable gross charges instead of the contracted rate."},{"payer_name":"Rexburg Care and Rehab","plan_name":"COMM","standard_charge_dollar":13333.34,"methodology":"fee schedule"},{"payer_name":"Select Health Idaho (EIRMC only)","plan_name":"HIX","standard_charge_dollar":34796.36,"methodology":"fee schedule"},{"payer_name":"Select Health Idaho (EIRMC only)","plan_name":"PPO","standard_charge_dollar":34796.36,"methodology":"fee schedule"},{"payer_name":"Select Health Idaho (EIRMC only)","plan_name":"SelectMed","standard_charge_dollar":37499.75,"methodology":"fee schedule"},{"payer_name":"Shashone-Bannock Tribal Health","plan_name":"FED","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shashone-Bannock Tribal Health","plan_name":"MCR","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St. John's Health Network","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":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":13333.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11144.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $399800.00, reimbursement will be $7898 per diem instead of the contracted rate."},{"payer_name":"United  ","plan_name":"MGMCR","standard_charge_dollar":12666.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":69.90,"standard_charge_algorithm":"Reimbursement will be 69.9% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"University of Utah","plan_name":"HIX","standard_charge_dollar":38689.79,"methodology":"fee schedule"},{"payer_name":"University of Utah","plan_name":"HMP","standard_charge_dollar":38689.79,"methodology":"fee schedule"},{"payer_name":"University of Utah","plan_name":"PPO","standard_charge_dollar":38689.79,"methodology":"fee schedule"},{"payer_name":"Value Options","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% 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":13333.34,"methodology":"fee schedule"}]}]},{"description":"RESUSCITATOR ADLT MASK ","code_information":[{"code":"569396","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":115.00,"maximum":115.00,"gross_charge":420.00,"discounted_cash":420.00,"payers_information":[{"payer_name":"Aetna","plan_name":"CWI","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":189.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"IdahoEnvironmentalCoalition","standard_charge_percentage":39.40,"standard_charge_algorithm":"Reimbursement will be 39.4% of billable gross charges.","estimated_amount":165.48,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PEAKPERFERENCE","standard_charge_percentage":48.70,"standard_charge_algorithm":"Reimbursement will be 48.7% of billable gross charges.","estimated_amount":204.54,"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":399.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"POS","standard_charge_percentage":57.80,"standard_charge_algorithm":"Reimbursement will be 57.8% of billable gross charges.","estimated_amount":242.76,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"PPO","standard_charge_percentage":57.80,"standard_charge_algorithm":"Reimbursement will be 57.8% of billable gross charges.","estimated_amount":242.76,"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":399.00,"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":399.00,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"TRAD","standard_charge_percentage":57.80,"standard_charge_algorithm":"Reimbursement will be 57.8% of billable gross charges.","estimated_amount":242.76,"methodology":"percent of total billed charges"},{"payer_name":"Business Psychology Associates","plan_name":"COMM","standard_charge_dollar":115.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":56.50,"standard_charge_algorithm":"Reimbursement will be 56.5% of billable gross 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charges.","estimated_amount":280.98,"methodology":"percent of total billed charges"},{"payer_name":"Doug Andrus Distributing","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":168.00,"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":336.00,"methodology":"percent of total billed charges"},{"payer_name":"First Choice Health Of Washington","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":252.00,"methodology":"percent of total billed charges"},{"payer_name":"First Choice of the Midwest","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":378.00,"methodology":"percent of total billed charges"},{"payer_name":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":336.00,"methodology":"percent of total billed charges"},{"payer_name":"Intermountain Healthcare","plan_name":"HIX","standard_charge_percentage":31.50,"standard_charge_algorithm":"Reimbursement will be 31.5% of billable gross charges.","estimated_amount":132.30,"methodology":"percent of total billed charges"},{"payer_name":"Intermountain Healthcare","plan_name":"PPO","standard_charge_percentage":31.50,"standard_charge_algorithm":"Reimbursement will be 31.5% of billable gross charges.","estimated_amount":132.30,"methodology":"percent of total billed charges"},{"payer_name":"Interwest Health","plan_name":"PPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":378.00,"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":190.26,"methodology":"percent of total billed charges"},{"payer_name":"Mountain Health Co-Op","plan_name":"Group","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":315.00,"methodology":"percent of total billed charges"},{"payer_name":"Mountain Health Co-Op","plan_name":"Individual","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":210.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":378.00,"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":84.00,"standard_charge_algorithm":"Reimbursement will be 84% of billable gross charges.","estimated_amount":352.80,"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":"CCNNetworks","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":184.80,"methodology":"percent of total billed charges"},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":231.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"GROUPHEALTH","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":357.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"INDIGENTCARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":315.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WCOMP","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":357.00,"methodology":"percent of total billed charges"},{"payer_name":"Select Health Idaho (EIRMC only)","plan_name":"HIX","standard_charge_percentage":31.50,"standard_charge_algorithm":"Reimbursement will be 31.5% of billable gross charges.","estimated_amount":132.30,"methodology":"percent of total billed charges"},{"payer_name":"Select Health Idaho (EIRMC only)","plan_name":"PPO","standard_charge_percentage":31.50,"standard_charge_algorithm":"Reimbursement will be 31.5% of billable gross charges.","estimated_amount":132.30,"methodology":"percent of total billed charges"},{"payer_name":"Select Health Idaho (EIRMC only)","plan_name":"SelectMed","standard_charge_percentage":35.10,"standard_charge_algorithm":"Reimbursement will be 35.1% of billable gross charges.","estimated_amount":147.42,"methodology":"percent of total billed charges"},{"payer_name":"Shashone-Bannock Tribal Health","plan_name":"FED","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":420.00,"methodology":"percent of total billed charges"},{"payer_name":"Shashone-Bannock Tribal Health","plan_name":"MCR","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":420.00,"methodology":"percent of total billed charges"},{"payer_name":"St. John's Health Network","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":378.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":336.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":63.50,"standard_charge_algorithm":"Reimbursement will be 63.5% of billable gross charges.","estimated_amount":266.70,"methodology":"percent of total billed 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logic."},{"payer_name":"PacificSource Health","plan_name":"CCNNetworks","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":1043.68,"methodology":"percent of total billed charges"},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":1304.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"GROUPHEALTH","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2016.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"INDIGENTCARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1779.00,"methodology":"percent of total 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charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":21168.71,"methodology":"fee schedule"},{"payer_name":"Mountain Health Co-Op","plan_name":"Group","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Mountain Health Co-Op","plan_name":"Individual","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","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 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total billed charges"},{"payer_name":"Aetna","plan_name":"IdahoEnvironmentalCoalition","standard_charge_percentage":39.40,"standard_charge_algorithm":"Reimbursement will be 39.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PEAKPERFERENCE","standard_charge_percentage":47.10,"standard_charge_algorithm":"Reimbursement will be 47.1% 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":13664.77,"methodology":"fee schedule"},{"payer_name":"Blue Cross","plan_name":"POS","standard_charge_dollar":40593.98,"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":40593.98,"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":40593.98,"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":825.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":56.50,"standard_charge_algorithm":"Reimbursement will be 56.5% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Coventry First Health","plan_name":"COMM","standard_charge_percentage":91.00,"standard_charge_algorithm":"Reimbursement will be 91% 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":91.00,"standard_charge_algorithm":"Reimbursement will be 91% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DMBA","plan_name":"HMO","standard_charge_dollar":39311.41,"methodology":"fee schedule"},{"payer_name":"DMBA","plan_name":"PPO","standard_charge_dollar":39311.41,"methodology":"fee schedule"},{"payer_name":"Donor Services","plan_name":"LOCALGOV","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":"Doug Andrus Distributing","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% 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":"First Choice Health Of Washington","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"First Choice of the Midwest","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":"GEHA PPO USA","plan_name":"COMM","standard_charge_percentage":83.00,"standard_charge_algorithm":"Reimbursement will be 83% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRHMO","standard_charge_dollar":13800.07,"methodology":"fee schedule"},{"payer_name":"Humana ChoiceChoice","plan_name":"MCRPPO","standard_charge_dollar":13800.07,"methodology":"fee schedule"},{"payer_name":"Intermountain Healthcare","plan_name":"HIX","standard_charge_dollar":31680.10,"methodology":"fee schedule"},{"payer_name":"Intermountain Healthcare","plan_name":"PPO","standard_charge_dollar":31680.10,"methodology":"fee schedule"},{"payer_name":"Interwest 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":"Interwest Health","plan_name":"WC","standard_charge_dollar":15070.50,"methodology":"fee schedule"},{"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":13529.48,"methodology":"fee schedule"},{"payer_name":"Mountain Health Co-Op","plan_name":"Group","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Mountain Health Co-Op","plan_name":"Individual","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARY","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":"Multiplan","plan_name":"PRIMARY","standard_charge_percentage":84.00,"standard_charge_algorithm":"Reimbursement will be 84% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PacificSource Health","plan_name":"CCNNetworks","standard_charge_dollar":34262.02,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $89423.86, charges over the threshold will be paid at 47.1% of billable gross charges in addition to the contracteded rate."},{"payer_name":"PacificSource Health","plan_name":"PPO","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"GROUPHEALTH","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"INDIGENTCARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"MCR","standard_charge_dollar":13529.48,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WCOMP","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Regence","plan_name":"PPO","standard_charge_dollar":35336.30,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: If billable gross charges exceed threshold of $408,240, reimbursement will be 37% of billable gross charges instead of the contracted rate. If billable gross charges exceed threshold of $1,000,000, reimbursement will be 16% of billable gross charges instead of the contracted rate."},{"payer_name":"Rexburg Care and Rehab","plan_name":"COMM","standard_charge_dollar":13529.48,"methodology":"fee schedule"},{"payer_name":"Select Health Idaho (EIRMC only)","plan_name":"HIX","standard_charge_dollar":31689.51,"methodology":"fee schedule"},{"payer_name":"Select Health Idaho (EIRMC only)","plan_name":"PPO","standard_charge_dollar":31689.51,"methodology":"fee schedule"},{"payer_name":"Select Health Idaho (EIRMC only)","plan_name":"SelectMed","standard_charge_dollar":34151.52,"methodology":"fee schedule"},{"payer_name":"Shashone-Bannock Tribal Health","plan_name":"FED","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shashone-Bannock Tribal Health","plan_name":"MCR","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"St. John's Health Network","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":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":13529.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":33814.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $399800.00, reimbursement will be $7898 per diem instead of the contracted rate."},{"payer_name":"United  ","plan_name":"MGMCR","standard_charge_dollar":12853.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":69.90,"standard_charge_algorithm":"Reimbursement will be 69.9% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"University of Utah","plan_name":"HIX","standard_charge_dollar":40817.69,"methodology":"fee schedule"},{"payer_name":"University of Utah","plan_name":"HMP","standard_charge_dollar":40817.69,"methodology":"fee schedule"},{"payer_name":"University of Utah","plan_name":"PPO","standard_charge_dollar":40817.69,"methodology":"fee schedule"},{"payer_name":"Value Options","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% 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":13529.48,"methodology":"fee schedule"}]}]},{"description":"SPLINT FINGER SZ 7 ","code_information":[{"code":"571607","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":115.00,"maximum":115.00,"gross_charge":254.00,"discounted_cash":254.00,"payers_information":[{"payer_name":"Aetna","plan_name":"CWI","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":114.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"IdahoEnvironmentalCoalition","standard_charge_percentage":39.40,"standard_charge_algorithm":"Reimbursement will be 39.4% of billable gross charges.","estimated_amount":100.08,"methodology":"percent of total billed 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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":241.30,"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":241.30,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross","plan_name":"TRAD","standard_charge_percentage":57.80,"standard_charge_algorithm":"Reimbursement will be 57.8% of billable gross charges.","estimated_amount":146.81,"methodology":"percent of total billed charges"},{"payer_name":"Business Psychology Associates","plan_name":"COMM","standard_charge_dollar":115.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":56.50,"standard_charge_algorithm":"Reimbursement will be 56.5% of billable gross 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charges"},{"payer_name":"University of Utah","plan_name":"HIX","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":111.76,"methodology":"percent of total billed charges"},{"payer_name":"University of Utah","plan_name":"HMP","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":111.76,"methodology":"percent of total billed charges"},{"payer_name":"University of Utah","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":111.76,"methodology":"percent of total billed charges"}]}]},{"description":"SPLINT NSL 4.5CMX2CM THK ","code_information":[{"code":"111235","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":115.00,"maximum":115.00,"gross_charge":540.00,"discounted_cash":540.00,"payers_information":[{"payer_name":"Aetna","plan_name":"CWI","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":243.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"IdahoEnvironmentalCoalition","standard_charge_percentage":39.40,"standard_charge_algorithm":"Reimbursement will be 39.4% of billable gross charges.","estimated_amount":212.76,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PEAKPERFERENCE","standard_charge_percentage":48.70,"standard_charge_algorithm":"Reimbursement will be 48.7% of billable gross charges.","estimated_amount":262.98,"methodology":"percent of total billed charges"},{"payer_name":"Blue 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