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adjustment for the item or service to which the modifier is appended"},{"payer_name": "BCBS - ND","plan_name": "Medicare|All Plans","description": "150% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "BCBS - ND","plan_name": "Commercial|All Plans","description": "150% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "Sanford Health Plan","plan_name": "Commercial|NDPERS","description": "150% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "Great Plains","plan_name": "Medicare|All Plans","description": "150% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "United","plan_name": "Medicare|All Plans","description": "150% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "Humana","plan_name": "Medicare|All Plans","description": "150% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "Medica","plan_name": "Medicare|All Plans","description": "150% payment adjustment for the item or service to which the modifier is appended"}]},{"description": "Item designated by FDA as Class III Devices", "code": "KF", "modifier_payer_information": [{"payer_name": "Medica","plan_name": "Medicare|All Plans","description": "116% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "Humana","plan_name": "Medicare|All Plans","description": "116% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "United","plan_name": "Medicare|All Plans","description": "116% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "Great Plains","plan_name": "Medicare|All Plans","description": "116% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "BCBS - ND","plan_name": "Medicare|All Plans","description": "116% payment adjustment for the item or service to which the modifier is appended"}]},{"description": "Replacement of facial prosthesis including new impression/moulage", "code": "KM", "modifier_payer_information": [{"payer_name": "Humana","plan_name": "Medicare|All Plans","description": "95% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "Great Plains","plan_name": "Medicare|All Plans","description": "95% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "BCBS - ND","plan_name": "Medicare|All Plans","description": "95% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "United","plan_name": "Medicare|All Plans","description": "95% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "Medica","plan_name": "Medicare|All Plans","description": "95% payment adjustment for the item or service to which the modifier is appended"}]},{"description": "Replacement of facial prosthesis", "code": "KN", "modifier_payer_information": [{"payer_name": "Humana","plan_name": "Medicare|All Plans","description": "40% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "Great Plains","plan_name": "Medicare|All Plans","description": "40% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "BCBS - ND","plan_name": "Medicare|All Plans","description": "40% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "United","plan_name": "Medicare|All Plans","description": "40% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "Medica","plan_name": "Medicare|All Plans","description": "40% payment adjustment for the item or service to which the modifier is appended"}]}],"general_contract_provisions": [ 
{ "payer_name": "BCBS - ND", "plan_name": "Commercial|All Plans", "description": "Inpatient - Reimbursement for the entire encounter may be limited to 150 Percent of Billed Charges" },{ "payer_name": "Sanford Health Plan", "plan_name": "Commercial|All Other Plans", "description": "Inpatient - Reimbursement for the entire encounter may be 69.99 Percent of Billed Charges when Billed Charges exceeds a threshold of $113,062.00/Inpatient - Reimbursement for the entire encounter may be limited to 100 Percent of Billed Charges" },{ "payer_name": "Sanford Health Plan", "plan_name": "Commercial|NDPERS", "description": "Inpatient - Reimbursement for the entire encounter may be 69.99 Percent of Billed Charges when Billed Charges exceeds a threshold of $113,062.00/Inpatient - Reimbursement for the entire encounter may be limited to 100 Percent of Billed Charges" },{ "payer_name": "United", "plan_name": "Commercial|All Plans", "description": "Inpatient - Reimbursement for the entire encounter may be limited to 100 Percent of Billed Charges/Inpatient - Reimbursement for the entire encounter may be 63.6 Percent of Billed Charges when Billed Charges exceeds a threshold of $283,450.00" },{ "payer_name": "BCBS - ND", "plan_name": "Medicaid|All Plans", "description": "Inpatient - Reimbursement for the entire encounter may be limited to 100 Percent of Billed Charges" },{ "payer_name": "BCBS - ND", "plan_name": "Medicare|All Plans", "description": "Inpatient - Reimbursement for the entire encounter may be limited to 100 Percent of Billed Charges" },{ "payer_name": "United", "plan_name": "Medicare|All Plans", "description": "Outpatient - Reimbursement for the entire encounter may be limited to 100 Percent of Billed Charges" }]}